Preconception Cardiovascular Risk Factor Differences Between Gestational Hypertension and Preeclampsia: Cohort Norway Study.
Preconception Cardiovascular Risk Factor Differences Between Gestational Hypertension and Preeclampsia: Cohort Norway Study.
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DOI：
10.1161/hypertensionaha.116.07099
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发表时间：
2016-06
期刊：
影响因子：
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通讯作者：
Skjærven R
中科院分区：
文献类型：
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作者：
Egeland GM;Klungsøyr K;Øyen N;Tell GS;Næss Ø;Skjærven R
补充数字内容可在文本中找到。妊娠期高血压和先兆子痫的孕前预测因子可能会发现早期检测的机会，并提高我们对这些疾病的发病机制和生命过程流行病学的理解。1994年至2003年，通过与挪威医学出生登记处的记录联系，对挪威社区队列健康调查的女性参与者进行了前瞻性随访，直至2012年。分析包括13217例无高血压的单胎妊娠（8321例妇女平均1.59例分娩）。结局为妊娠期高血压无蛋白尿（n=237）和先兆子痫（n=429）。基线时的平均年龄（SD）为27.9岁（4.5岁），中位随访时间为4.8年（四分位数范围2.6-7.8）。妊娠期高血压和先兆子痫共有几个基线风险因素：糖尿病家族史、妊娠前糖尿病、高总胆固醇/高密度脂蛋白胆固醇比值（>5）、超重和肥胖以及血压升高。对于先兆子痫，60岁以前的心肌梗死家族史和甘油三酯水平升高（≥1.7 mmol/L）也可预测风险，而体力活动具有保护作用。早产儿先兆子痫的预测标准为过去一年的酗酒（一次饮酒≥5杯），调整后的比值比为3.7（95%置信区间1.3-10.8），过去一年每周体力活动≥3小时，调整后的比值比为0.5（95%置信区间0.3-0.8）。结果提示妊娠期高血压、先兆子痫和早产先兆子痫之间的相似性和重要差异。可改变的风险因素可以作为改善妊娠结局以及母亲和后代的短期和长期后遗症的目标。
Supplemental Digital Content is available in the text. Preconception predictors of gestational hypertension and preeclampsia may identify opportunities for early detection and improve our understanding of the pathogenesis and life course epidemiology of these conditions. Female participants in community-based Cohort Norway health surveys, 1994 to 2003, were prospectively followed through 2012 via record linkages to Medical Birth Registry of Norway. Analyses included 13 217 singleton pregnancies (average of 1.59 births to 8321 women) without preexisting hypertension. Outcomes were gestational hypertension without proteinuria (n=237) and preeclampsia (n=429). Mean age (SD) at baseline was 27.9 years (4.5), and median follow-up was 4.8 years (interquartile range 2.6–7.8). Gestational hypertension and preeclampsia shared several baseline risk factors: family history of diabetes mellitus, pregravid diabetes mellitus, a high total cholesterol/high-density lipoprotein cholesterol ratio (>5), overweight and obesity, and elevated blood pressure status. For preeclampsia, a family history of myocardial infarction before 60 years of age and elevated triglyceride levels (≥1.7 mmol/L) also predicted risk while physical activity was protective. Preterm preeclampsia was predicted by past-year binge drinking (≥5 drinks on one occasion) with an adjusted odds ratio of 3.7 (95% confidence interval 1.3–10.8) and by past-year physical activity of ≥3 hours per week with an adjusted odds ratio of 0.5 (95% confidence interval 0.3–0.8). The results suggest similarities and important differences between gestational hypertension, preeclampsia, and preterm preeclampsia. Modifiable risk factors could be targeted for improving pregnancy outcomes and the short- and long-term sequelae for mothers and offspring.