Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study.
Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study.
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DOI：
10.1136/bmj.b2255
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发表时间：
2009-06-18
期刊：
影响因子：
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通讯作者：
Cnattingius S
中科院分区：
文献类型：
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作者：
Hernández-Díaz S;Toh S;Cnattingius S
目的 调查先兆子痫在第一次妊娠中是否更常见，是否仅仅是因为受影响的女性较少（可能有较高的复发风险）继续进行后续妊娠。设计前瞻性队列研究。设置瑞典医疗出生登记。参与者 763–795 名 1987 年至 2004 年期间在瑞典生下第一胎的初产母亲。主要结果指标 先兆子痫。结果 首次妊娠时先兆子痫的风险为 4.1%，以后妊娠时为 1.7%。然而，对于第一次怀孕时患有先兆子痫的女性，第二次怀孕的风险为 14.7%，而对于前两次怀孕时患有先兆子痫的女性，第二次怀孕的风险为 31.9%。无先兆子痫病史的经产妇女的风险约为 1%。与妊娠 34 周前分娩相关的先兆子痫的发生率在初产妇中为 0.42%，在无先兆子痫病史的经产妇中为 0.11%，在曾经妊娠过 1 次或 2 次的妇女中分别为 6.8% 和 12.5%。患有任何先兆子痫的女性在怀孕后继续妊娠的比例会降低 4-5%，但如果先兆子痫与极早产有关，则进一步妊娠的比例会降低 10% 以上。经产妇女先兆子痫的估计风险并没有随着妊娠率的标准化而改变。结论 一次妊娠中出现先兆子痫对于后续妊娠的预测效果较差，但对于未来妊娠中先兆子痫复发的预测作用较强。经产妇女患先兆子痫的总体风险较低，这并不是因为在前一次妊娠期间患有先兆子痫的妇女受孕较少。早发性先兆子痫可能与未来怀孕的可能性降低有关，并且在再次怀孕时比晚发性先兆子痫更容易复发。研究结果与两种不同病症的存在相一致：一种是受遗传或环境等慢性因素影响的严重复发性早发型，另一种是受短暂因素影响的较温和散发型。
Objective To investigate whether pre-eclampsia is more common in first pregnancies solely because fewer affected women, who presumably have a higher risk of recurrence, go on to have subsequent pregnancies. Design Prospective cohort study. Setting Swedish Medical Birth Register. Participants 763 795 primiparous mothers who had their first births in Sweden, 1987-2004. Main outcome measures Pre-eclampsia. Results The risk of pre-eclampsia was 4.1% in the first pregnancy and 1.7% in later pregnancies overall. However, the risk was 14.7% in the second pregnancy for women who had had pre-eclampsia in their first pregnancy and 31.9% for women who had had pre-eclampsia in the previous two pregnancies. The risk for multiparous women without a history of pre-eclampsia was around 1%. The incidence of pre-eclampsia associated with delivery before 34 weeks’ gestation was 0.42% in primiparous women, 0.11% in multiparous women without a history of pre-eclampsia, and 6.8% and 12.5% in women who had had one or two previous pregnancies affected, respectively. The proportion of women who went on to have a further pregnancy was 4-5% lower after having a pregnancy with any pre-eclampsia but over 10% lower if pre-eclampsia was associated with very preterm delivery. The estimated risk of pre-eclampsia in parous women did not change with standardisation for pregnancy rates. Conclusions Having pre-eclampsia in one pregnancy is a poor predictor of subsequent pregnancy but a strong predictor for recurrence of pre-eclampsia in future gestations. The lower overall risk of pre-eclampsia among parous women was not explained by fewer conceptions among women who had had pre-eclampsia in a previous gestation. Early onset pre-eclampsia might be associated with a reduced likelihood of a future pregnancy and with more recurrences than late onset pre-eclampsia when there are further pregnancies. Findings are consistent with the existence of two distinct conditions: a severe recurrent early onset type affected by chronic factors, genetic or environmental, and a milder sporadic form affected by transient factors.