Risk factors and clinical manifestations of pre-eclampsia
Risk factors and clinical manifestations of pre-eclampsia
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DOI：
10.1111/j.1471-0528.2000.tb11657.x
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发表时间：
2000-11-01
期刊：
影响因子：
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通讯作者：
Austgulen, R
中科院分区：
文献类型：
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作者：
Odegård, RA;Vatten, LJ;Austgulen, R
目的研究先兆子痫的危险因素与不同临床表现之间的关系。设计一项基于人群的巢式病例对照研究。资料来自出生诊所的12，804例连续分娩，这些分娩发生在三年以上，仅罗加兰县就有近24万人口，选择先兆子痫病例（n = 323）和健康对照（n = 650）。先兆子痫定义为妊娠20周后舒张压（大于或等于25 mmHg至大于或等于90 mmHg）和蛋白尿（试纸测试大于或等于1+）的增加。根据疾病的临床表现（即严重程度[轻度、中度或重度]）和发病时间（妊娠早期或晚期）对先兆子痫女性进行分组。与研究因素的关联估计为相对风险（比值比，OR）。结果未产妇和高血压增加先兆子痫的风险，没有明确的偏好，任何临床亚型。母亲体重高与轻度和中度先兆子痫的风险较高有关，但与重度先兆子痫无关。既往先兆子痫显著增加了当前妊娠中先兆子痫的风险，早发性疾病的风险尤其高（OR 42.4; 95%CI 11.9-151.6）。总体而言，吸烟与先兆子痫风险降低相关（OR 0.6; 95% CI 0.4-0.9）。然而，没有效果的吸烟观察在早发性疾病组和反复先兆子痫的妇女之间。结论Nulliparity和高血压增加了先兆子痫的每个亚组的风险，但高产妇体重，以前的先兆子痫和吸烟并不一贯与每个临床亚型。这一观察结果可能表明，先兆子痫的不同临床表现可能存在不同的病理机制。
Objective To study associations between established risk factors for pre-eclampsia and different clinical manifestations of the disease.Design A population-based, nested case-control study.Setting Information from 12,804 consecutive deliveries that took place over three years at a birth clinic, which alone serves a population of nearly 240,000 in Rogaland county, Norway.Subjects Cases of pre-eclampsia (n = 323) and healthy controls (n = 650) were selected. Pre-eclampsia was defined as increase in diastolic blood pressure (greater than or equal to 25 mmHg to greater than or equal to 90 mmHg) and proteinuria (greater than or equal to 1+ by dipstick testing) after 20 weeks of pregnancy.Main study measures Parity, previous pre-eclampsia, blood pressure, maternal weight, and maternal smoking were included as study variables. Women with pre-eclampsia were grouped according to clinical manifestations of the disease (i.e. severity [mild, moderate or severe]) and time of onset (early or late gestation). Associations with the study factors were estimated as relative risks (odds ratio, OR).Results Both nulliparity and hypertension increased pre-eclampsia risk, with no clear preference for any clinical subtype. High maternal weight was related to a higher risk of mild and moderate, but not severe, pre-eclampsia. Previous pre-eclampsia strongly increased the risk for pre-eclampsia in the current pregnancy, and the risk of early onset disease was especially high (OR 42.4; 95% CI 11.9-151.6). Overall, smoking was associated with a reduced risk for pre-eclampsia (OR 0.6; 95% CI 0.4-0.9). However, no effect of smoking was observed in the early onset disease group and among women with repeated pre-eclampsia.Conclusion Nulliparity and hypertension increased the risk for each subgroup of pre-eclampsia, but high maternal weight, previous pre-eclampsia and smoking were not consistently associated with each clinical subtype. This observation may suggest that heterogeneous clinical manifestations of pre-eclampsia may be preceded by different pathological mechanisms.