Chronic hypertension in pregnancy and the risk of congenital malformations: a cohort study.
Chronic hypertension in pregnancy and the risk of congenital malformations: a cohort study.
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DOI：
10.1016/j.ajog.2014.09.031
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发表时间：
2015-03
影响因子：
9.8
通讯作者：
Hernandez-Diaz, Sonia
中科院分区：
文献类型：
--
作者：
Bateman, Brian T.;Huybrechts, Krista F.;Fischer, Michael A.;Seely, Ellen W.;Ecker, Jeffrey L.;Oberg, Anna S.;Franklin, Jessica M.;Mogun, Helen;Hernandez-Diaz, Sonia
慢性高血压是妊娠期常见的疾病。这项研究的目的是检查母亲慢性高血压和后代先天性畸形风险之间的关系。我们使用Medicaid分析提取物定义了一个与婴儿医疗记录相关的878，126例已完成妊娠的队列。比较了血压正常对照组与治疗和未治疗的慢性高血压患者之间先天性畸形的风险。使用倾向评分匹配解决混杂因素。匹配后，与血压正常的对照组相比，合并治疗的慢性高血压的妊娠发生先天性畸形的风险增加（比值比（OR）1.3，95%置信区间（CI）1.2至1.5），合并未治疗的慢性高血压的妊娠发生先天性畸形的风险也增加（OR 1.2，95% CI 1.1至1.3）。在我们对器官特异性畸形的分析中，治疗和未治疗的慢性高血压均与心脏畸形风险显著增加相关（OR分别为1.6，95%CI 1.4至1.9和OR 1.5，95%CI 1.3至1.7）。这些关联在一系列敏感性分析中持续存在。与治疗和未治疗的慢性高血压相关的先天性畸形（特别是心脏畸形）风险增加相似，与测量的混杂因素无关。评价抗高血压药物致畸潜力的研究必须控制适应症的混杂因素。患有慢性高血压的母亲的胎儿和新生儿应仔细评估潜在的畸形，特别是心脏缺陷。
Chronic hypertension is a common medical condition in pregnancy. The purpose of the study is to examine the association between maternal chronic hypertension and the risk of congenital malformations in the offspring. We defined a cohort of 878,126 completed pregnancies linked to infant medical records using the Medicaid Analytic Extract. The risk of congenital malformations was compared between normotensive controls and those with treated and untreated chronic hypertension. Confounding was addressed using propensity score matching. After matching, compared to normotensive controls, pregnancies complicated by treated chronic hypertension were at increased risk of congenital malformations (odds ratio (OR) 1.3, 95% confidence interval (CI) 1.2 to 1.5), as were pregnancies with untreated chronic hypertension (OR 1.2, 95% CI 1.1 to 1.3). In our analysis of organ-specific malformations, both treated and untreated chronic hypertension were associated with a significant increase in the risk of cardiac malformations (OR 1.6, 95% CI 1.4 to 1.9 and OR 1.5, 95% CI 1.3 to 1.7, respectively). These associations persisted across a range of sensitivity analyses. There is a similar increase in the risk of congenital malformations (particularly cardiac malformations) associated with treated and untreated chronic hypertension that is independent of measured confounders. Studies evaluating the teratogenic potential of antihypertensive medications must control for confounding by indication. Fetuses and neonates of mothers with chronic hypertension should be carefully evaluated for potential malformations, particularly cardiac defects.
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影响因子：
9.8
作者：
Bateman BT;Bansil P;Hernandez-Diaz S;Mhyre JM;Callaghan WM;Kuklina EV
通讯作者：
Kuklina EV
影响因子：
158.5
作者：
Sibai, BM;Lindheimer, M;Dombrowski, M
通讯作者：
Dombrowski, M
影响因子：
3.7
作者：
Palmsten, Kristin;Huybrechts, Krista F.;Hernandez-Diaz, Sonia
通讯作者：
Hernandez-Diaz, Sonia
影响因子：
3.1
作者：
Allen, Victoria M;Joseph, KS;Ohlsson, Arne
通讯作者：
Ohlsson, Arne
影响因子：
3.3
作者：
Källén, BAJ;Olausson, PO
通讯作者：
Olausson, PO