Maternal Obesity and the Risk of Early-Onset and Late-Onset Hypertensive Disorders of Pregnancy
Maternal Obesity and the Risk of Early-Onset and Late-Onset Hypertensive Disorders of Pregnancy
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DOI：
10.1097/a0g.0000000000003901
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发表时间：
2020-07-01
影响因子：
7.2
通讯作者：
Sibai, Baha M.
中科院分区：
文献类型：
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作者：
Bicocca, Matthew J.;Mendez-Figueroa, Hector;Sibai, Baha M.
目的：探讨产妇分娩时体重指数（BMI）与妊娠期早发性和晚发性高血压疾病发生率的关系。方法：我们使用2014年至2017年美国生命统计与时期相关的出生和婴儿死亡证明进行了一项基于人群的回顾性队列研究。包括在妊娠24至41周内分娩无异常单胎活产儿的妇女。我们排除了患有慢性高血压和bmi低于18.5的女性。主要暴露是母亲的BMI，定义为非肥胖（BMI 18.5-29.9；参照组），1级肥胖（BMI 30.0-34.9）， 2级肥胖（BMI 35.0-39.9）和3级肥胖（BMI 40.0或更高）。主要结局是妊娠期高血压疾病（妊娠期高血压、先兆子痫或子痫）分娩时小于34周或大于34周。多变量泊松回归用于估计相关风险和调整混杂变量。结果以校正相对危险度（aRR）和95% ci表示。结果：在研究期间的1580万活产妇女中，1400万（88.6%）符合纳入标准，825,722（5.9%）患有妊娠期高血压疾病。与非肥胖妇女相比，1级肥胖妇女（aRR 1.13; 95% CI 1.10-1.16）、2级肥胖妇女（aRR 1.57; 95% CI 1.53-1.62）和3级肥胖妇女（aRR 2.18; 95% CI 2.12-2.24）发生早发性妊娠高血压疾病的风险明显更高。与非肥胖妇女相比，1级肥胖妇女（aRR 1.71; 95% CI 1.70-1.73）、2级肥胖妇女（aRR 2.60; 95% CI 2.58-2.62）和3级肥胖妇女（aRR 3.93; 95% CI 3.91-3.96）发生妊娠迟发性高血压疾病的风险也显著增加。结论：与非肥胖妇女相比，妊娠期早发性和晚发性高血压疾病的风险在肥胖级别增加的妇女中显著递增。
OBJECTIVE: To evaluate the relationship between maternal body mass index (BMI) at delivery and rates of early-onset and late-onset hypertensive disorders of pregnancy. METHODS: We performed a population-based, retrospective cohort study using U.S. Vital Statistics period-linked birth and infant death certificates from 2014 to 2017. Women who delivered a nonanomalous singleton live neonate from 24 to 41 completed weeks of gestation were included. We excluded women with chronic hypertension and those with BMIs less than 18.5. The primary exposure was maternal BMI, defined as nonobese (BMI 18.5-29.9; referent group), class 1 obesity (BMI 30.0-34.9), class 2 obesity (BMI 35.0-39.9), and class 3 obesity (BMI 40.0 or greater). The primary outcome was delivery with hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, or eclampsia) at less than 34 weeks of gestation or at 34 weeks or more. Multivariable Poisson regression was used to estimate relate risk and adjust for confounding variables. Results are presented as adjusted relative risk (aRR) and 95% CIs. RESULTS: Of the 15.8 million women with live births during the study period, 14.0 million (88.6%) met inclusion criteria, and 825,722 (5.9%) had hypertensive disorders of pregnancy. The risk of early-onset hypertensive disorders of pregnancy was significantly higher in women with class 1 obesity (aRR 1.13; 95% CI 1.10-1.16), class 2 obesity (aRR 1.57; 95% CI 1.53-1.62), and class 3 obesity (aRR 2.18; 95% CI 2.12-2.24), compared with nonobese women. The risk of late-onset hypertensive disorders of pregnancy was also significantly increased in women with class 1 obesity (aRR 1.71; 95% CI 1.70-1.73), class 2 obesity (aRR 2.60; 95% CI 2.58-2.62), and class 3 obesity (aRR 3.93; 95% CI 3.91-3.96) compared with nonobese women. CONCLUSION: Compared with nonobese women, the risk of early-onset and late-onset hypertensive disorders of pregnancy is significantly and progressively increased among women with increased class of obesity.