Chronic hypertension, perinatal mortality and the impact of preterm delivery: a population-based study.
Chronic hypertension, perinatal mortality and the impact of preterm delivery: a population-based study.
复制标题
DOI：
10.1111/1471-0528.16932
复制
发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
评估慢性高血压与围产儿死亡率之间的关系，并评估早产对风险的影响程度。横断面分析。美国，2015-18年。单胎出生(怀孕20-44周)。慢性高血压，定义为怀孕前诊断的或怀孕20周前发现的血压升高。我们从泊松模型中得出了与慢性高血压有关的围产儿死亡风险，并对混杂因素进行了调整。评估了错误分类和不可测量的混淆的影响。因果中介分析被用来量化早产对这种联系的影响。在15090678名单胎新生儿中，慢性高血压组和正常血压组围产儿死亡率分别为22.5/1000和8.2/1000(调整后的危险比为2.05，95%可信区间为2.00~2.10)。对暴露的错误分类和未测量的混淆偏差的校正大大增加了风险估计。尽管因果中介分析显示，慢性高血压与围产儿死亡的关系大部分是通过早产来调节的，但围产儿死亡率在早孕、足月和晚期妊娠时最高，这表明计划在37-386/7周的早产可能是这些妊娠风险的最佳平衡。此外，如果慢性高血压导致的早产是可预防的，87%(95%可信区间84-90%)的围产儿死亡可以消除。慢性高血压与围产儿死亡风险增加有关。有计划的早产和针对慢性高血压的可改变的危险因素可能会降低围产儿死亡率。产妇慢性高血压与围产期死亡风险增加有关，这主要是由早产引起的。
To estimate the association between chronic hypertension and perinatal mortality and to evaluate the extent to which risks are impacted by preterm delivery. Cross-sectional analysis. United States, 2015–18. Singleton births (20–44 weeks of gestation). Chronic hypertension, defined as elevated blood pressure diagnosed before pregnancy or recognised before 20 weeks of gestation. We derived the risk of perinatal mortality in relation to chronic hypertension from Poisson models, adjusted for confounders. The impacts of misclassification and unmeasured confounding were assessed. Causal mediation analysis was performed to quantify the impact of preterm delivery on the association. Of the 15 090 678 singleton births, perinatal mortality rates were 22.5 and 8.2 per 1000 births in chronic hypertensive and normotensive pregnancies, respectively (adjusted risk ratio 2.05, 95% CI 2.00–2.10). Corrections for exposure misclassification and unmeasured confounding biases substantially increased the risk estimate. Although causal mediation analysis revealed that most of the association of chronic hypertension on perinatal mortality was mediated through preterm delivery, the perinatal mortality rates were highest at early term, term and late term gestations, suggesting that a planned early term delivery at 37–386/7 weeks may optimally balance risk in these pregnancies. Additionally, 87% (95% CI 84–90%) of perinatal deaths could be eliminated if preterm deliveries, as a result of chronic hypertension, were preventable. Chronic hypertension is associated with increased risk for perinatal mortality. Planned early term delivery and targeting modifiable risk factors for chronic hypertension may reduce perinatal mortality rates. Maternal chronic hypertension is associated with increased risk for perinatal mortality, largely driven by preterm birth.