The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study.
The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study.
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DOI：
10.1186/1471-2393-4-17
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发表时间：
2004-08-06
影响因子：
3.1
通讯作者：
Ohlsson, Arne
中科院分区：
文献类型：
--
作者：
Allen, Victoria M;Joseph, KS;Ohlsson, Arne
背景：怀孕的高血压疾病是孕产妇，胎儿和新生儿发病率以及全球死亡率的主要原因。但是，试图量化高血压对不良围产期结果影响的研究主要是在高等教育中心进行的。这项基于人群的研究探讨了怀孕中高血压疾病的频率以及胎龄（SGA）和死产的小小增加。方法：我们在1988年至2000年之间使用了有关加拿大新斯科舍省所有孕妇和出生的信息。如果出生体重<500克，则排除了怀孕怀孕（大于双胞胎妊娠）或主要的胎儿异常。结果：研究人群包括135,466例怀孕。其中，有7.7％患有轻度妊娠诱发的高血压（PIH），1.3％的患有严重的PIH，0.2％的HELLP（溶血，肝酶升高，低血小板），0.02％的eClampsia，0.6％的慢性高血压和0.4％患有慢性高血压，并叠加了PIH。与正常女性相比，怀孕期间任何高血压的妇女的现场生产物的可能性为1.6（95％CI 1.5-1.6）的可能性高出1.6（95％CI 1.1-1.8）的可能性高于1.4（95％CI 1.1-1.8）倍，与正常的女性相比，死产的可能性高。调整后的分析表明，患有妊娠高血压的女性没有蛋白尿（轻度PIH）和蛋白尿（严重的PIH，HELLP或ECLAMPSIA）更有可能患有SGA婴儿（RR 1.5，95％CI 1.4-1.6和RR 3.2，95％，RR 3.2，95％ CI 2.8-3.6）。患有预先存在高血压的妇女也更有可能生下患有SGA的婴儿（RR 2.5，95％CI 2.2-3.0）或死产（RR 3.2，95％CI 1.9-5.4）。结论：这项基于人群的大型研究证实并量化了妊娠年龄和孕妇中胎龄小的过量风险的大小，对怀孕的高血压疾病女性。
BACKGROUND: Hypertensive disorders in pregnancy are leading causes of maternal, fetal and neonatal morbidity and mortality worldwide. However, studies attempting to quantify the effect of hypertension on adverse perinatal outcomes have been mostly conducted in tertiary centres. This population-based study explored the frequency of hypertensive disorders in pregnancy and the associated increase in small for gestational age (SGA) and stillbirth. METHODS: We used information on all pregnant women and births, in the Canadian province of Nova Scotia, between 1988 and 2000. Pregnancies were excluded if delivery occurred < 20 weeks, if birthweight was < 500 grams, if there was a high-order multiple pregnancy (greater than twin gestation), or a major fetal anomaly. RESULTS: The study population included 135,466 pregnancies. Of these, 7.7% had mild pregnancy-induced hypertension (PIH), 1.3% had severe PIH, 0.2% had HELLP (hemolysis, elevated liver enzymes, low platelets), 0.02% had eclampsia, 0.6% had chronic hypertension, and 0.4% had chronic hypertension with superimposed PIH. Women with any hypertension in pregnancy were 1.6 (95% CI 1.5-1.6) times more likely to have a live birth with SGA and 1.4 (95% CI 1.1-1.8) times more likely to have a stillbirth as compared with normotensive women. Adjusted analyses showed that women with gestational hypertension without proteinuria (mild PIH) and with proteinuria (severe PIH, HELLP, or eclampsia) were more likely to have infants with SGA (RR 1.5, 95% CI 1.4-1.6 and RR 3.2, 95% CI 2.8-3.6, respectively). Women with pre-existing hypertension were also more likely to give birth to an infant with SGA (RR 2.5, 95% CI 2.2-3.0) or to have a stillbirth (RR 3.2, 95% CI 1.9-5.4). CONCLUSIONS: This large, population-based study confirms and quantifies the magnitude of the excess risk of small for gestational age and stillbirth among births to women with hypertensive disease in pregnancy.