Hypertension and contraceptive use among women of child-bearing age in the United States from 2001 to 2018.
Hypertension and contraceptive use among women of child-bearing age in the United States from 2001 to 2018.
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DOI：
10.1097/hjh.0000000000003077
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发表时间：
2022-04-01
影响因子：
4.9
通讯作者：
Simas, Tiffany A. Moore
中科院分区：
文献类型：
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作者：
Kovell, Lara C.;Meyerovitz, Claire, V;Skaritanov, Ekaterina;Ayturk, Didem;Person, Sharina D.;Kumaraswami, Tara;Juraschek, Stephen P.;Simas, Tiffany A. Moore
关键词：
妊娠期高血压（HTN）是美国孕产妇死亡的主要原因。避孕被广泛使用，以雌激素为基础的联合激素形式已知会升高血压。由于近一半的怀孕是计划外的，而且许多抗高血压药物会致畸，因此适当的避孕对患有HTN的育龄妇女至关重要。利用2001年至2018年全国健康与营养调查（NHANES），我们评估了20-50岁育龄妇女避孕和抗高血压药物的使用情况。经历过绝育或更年期的妇女被排除在外。HTN的定义基于供方自我报告的诊断和血压≥130/80 mm Hg或使用抗高血压药物。避孕包括非屏障方法（药丸/贴片/环、注射、长效可逆避孕药具）或持续使用避孕套。采用多变量logistic回归对使用避孕药具的几率进行建模。报告了避孕措施使用的时间趋势。在8726名女性中，13.5%患有HTN，平均年龄（标准误差）36.0（0.3）岁。在HTN妇女中，9.2%使用非屏障避孕措施，10.4%仅使用避孕套。超过一半（52.7%）的HTN患者在服用降压药期间服用了禁忌药物，且避孕状况无差异。在logistic回归模型中，老年妇女的避孕药具使用率较低。在采用非屏障避孕的HTN妇女中，联合激素避孕药的使用率从100%（2001-2006年）下降到81.4%（2013-2018年，P < 0.001）。许多自我报告HTN的妇女没有采取适当的避孕措施。在使用非屏障避孕药具的一小部分人中，大多数使用的是基于雌激素的提高血压的方法。
Hypertension (HTN) in pregnancy is a leading cause of maternal mortality in the United States. Contraception is widely used, and estrogen-based combined hormonal forms are known to increase blood pressure (BP). With nearly half of pregnancies unplanned and many antihypertensive medications teratogenic, appropriate contraception is critical in child-bearing age women with HTN. Using the National Health and Nutrition Examination Surveys (NHANES) from 2001 to 2018, we evaluated contraception and antihypertensive medication use in women of child-bearing age (20–50 years). Women who had undergone sterilization or menopause were excluded. HTN was defined based on a self-reported provider diagnosis and BP ≥ 130/80 mm Hg or antihypertensive medication use. Contraception included non-barrier methods (pills/patch/ring, injections, long-acting reversible contraceptives) or consistent condom use. Multivariable logistic regression was used to model the odds of contraception use. Temporal trends in contraception use were reported. Of the 8726 women, 13.5% had HTN with mean age (standard error) 36.0 (0.3) years. In women with HTN, 9.2% used non-barrier contraception and 10.4% used condoms only. Over half (52.7%) of women with HTN on antihypertensive medications were taking medications contraindicated in pregnancy, with no difference seen by contraception status. In logistic regression models, contraception use was lower in the older-aged women. In women with HTN on non-barrier contraception, combined hormonal contraceptive use declined, from 100% (2001–2006) to 81.4% (2013–2018, P < 0.001). Many women with self-reported HTN are not using adequate contraception. Of the small proportion on non-barrier contraceptives, the majority are using estrogen-based, BP-raising methods.