Impact of pregnancy-induced hypertension on stillbirth and neonatal mortality.
Impact of pregnancy-induced hypertension on stillbirth and neonatal mortality.
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DOI：
10.1097/ede.0b013e3181c297af
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发表时间：
2010-01
期刊：
影响因子：
--
通讯作者：
Basso O
中科院分区：
文献类型：
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作者：
Ananth CV;Basso O
妊娠期高血压疾病在初产妇中更常见，但在多胎妊娠中可能更严重。我们研究了妊娠高血压（PIH）相关死产和新生儿死亡率的趋势，并探讨了死亡率是否因胎次和母亲种族而异。我们对1990年至2004年美国5700万例单胎活产和死胎（24-46周）进行了基于人群的研究。我们比较了1990-91年和2003-04年的出生率，估计了与妊高征相关的死胎和新生儿死亡率和调整后的比值比（OR）。妊高征从1990年的3.0%上升到2004年的3.9%。在1990-91年和2003-04年期间，妊高征与死产和新生儿死亡的风险增加有关。我们在2003-04年对此进行了更详细的探讨，并观察到与第一次分娩的妇女（OR=1.52，95%CI =1.40-1.64）相比，第二次或更多次分娩的妇女（OR=2.24，95%CI =2.11-2.37）死产风险增加。新生儿死亡模式相似（第一胎OR=1.30，95%CI =1.18-1.43，第二胎或更高胎OR=1.64，95%CI =1.51-1.78）。多胎妊娠中，黑人妊高征与死胎的相关性（OR=2.93，95%CI =2.66-3.22）强于白人（OR=1.98，95%CI =1.83-2.14）。死产和新生儿死亡率的巨大负担与PIH相关，尤其是在经产妇中，这可能是由于疾病更严重的妇女，或者是由于基础疾病的负担更高。
Hypertensive disorders of pregnancy are more frequent in primiparous women, but may be more severe in multiparas. We examined trends in pregnancy-induced hypertension (PIH)-related stillbirth and neonatal mortality and explored whether mortality varied by parity and maternal race. We carried out a population-based study of 57 million singleton live- and stillbirths (24-46 weeks) in the United States between 1990 and 2004. We estimated rates and adjusted odds ratio (OR) of stillbirth and neonatal death in relation to PIH, comparing births in 1990-91 with 2003-04. PIH increased from 3.0% in 1990 to 3.9% in 2004. In both 1990-91 and 2003-04 periods, PIH was associated with an increased risk of stillbirth and neonatal death. We explored this in more detail in 2003-04, and observed that the increased risk of stillbirth was higher in women having their second or higher order births (OR=2.24, 95% confidence interval (CI)=2.11-2.37) compared with women having their first birth (OR=1.52, 95% CI=1.40-1.64). Patterns were similar for neonatal death (OR=1.30, 95% CI=1.18-1.43 in first and OR=1.64, 95% CI=1.51-1.78 in second or higher order births). Among multiparas, the association between PIH and stillbirth was stronger in Blacks (OR=2.93, 95% CI=2.66-3.22) than Whites (OR=1.98, 95% CI=1.83-2.14). A substantial burden of stillbirth and neonatal mortality is associated with PIH, especially among multiparas women, which may be due to more severe disease women, or to a higher burden of underlying disease.