Preconception cardiovascular risk factors and pregnancy outcome.
Preconception cardiovascular risk factors and pregnancy outcome.
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DOI：
10.1097/ede.0b013e318225c960
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发表时间：
2011-09
期刊：
影响因子：
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通讯作者：
Raitakari OT
中科院分区：
文献类型：
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作者：
Harville EW;Viikari JS;Raitakari OT
妊娠相关的心血管疾病与妊娠结局较差和以后生活中的心血管疾病有关。关于孕前心血管危险因素水平和妊娠并发症之间的关系知之甚少。来自芬兰年轻人心血管风险研究的数据与1142名初产妇的出生登记数据相关联。计算末次月经前研究访视的总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、血压、胰岛素和葡萄糖的标准化水平。这些因素作为孕龄、早产（<37周）、出生体重、低出生体重（<2500 g）、小于胎龄儿（体重<胎龄第10百分位数）、妊娠期高血压疾病和妊娠期糖尿病的预测因子，使用线性和Poisson回归，并校正年龄、体重指数、吸烟和社会经济状况。较高的甘油三酯与高血压疾病（校正风险比[aRR]= 1.42 [95%置信区间（CI）= 0.90-2.23]）、先兆子痫（1.70 [1.08-2.65]）和妊娠期糖尿病（1.68 [1.25-2.25]）的风险较高相关。剔除妊娠并发症妇女（n=30）后，收缩压与早产相关性的aRR估计值为1.23（95% CI= 0.99-1.54）;对于HDL-c和低出生体重，0.97（0.73-1.28）;舒张压和小于胎龄儿为0.98（0.81-1.20）;收缩压和小于胎龄儿为1.18（0.97-1.45）。妊娠前高血脂水平预示着先兆子痫和妊娠期糖尿病的风险增加。据报道，这些妊娠并发症与母亲后来的心血管疾病之间的联系可能至少部分地可以通过怀孕前的母亲状况来解释。在怀孕前改善心血管健康的干预措施可能会降低妊娠并发症的风险。
Pregnancy-related cardiovascular conditions are associated with both poorer pregnancy outcomes and cardiovascular disease later in life. Little is known about the relationship between preconception cardiovascular risk factor levels and pregnancy complications. Data from the Cardiovascular Risk in Young Finns Study were linked with birth registry data for 1142 primiparous women. Age-standardized levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, insulin, and glucose from the study visit prior to last menstrual period were calculated. These factors were examined as predictors of gestational age, preterm birth (<37 weeks), birthweight, low birthweight (<2500 g), small-for-gestational-age (weight <10th percentile for gestational age), hypertensive disorders of pregnancy, and gestational diabetes, using linear and Poisson regression with adjustment for age, body mass index, smoking, and socioeconomic status. Higher triglycerides were associated with a higher risk of hypertensive disorders (adjusted risk ratio [aRR]= 1.42 [95% confidence interval (CI) = 0.90–2.23]), pre-eclampsia (1.70 [1.08–2.65]), and gestational diabetes (1.68 [1.25–2.25]). After removing women with pregnancy complications (n=30), the estimated aRR for the association between systolic blood pressure and preterm birth was 1.23 (95% CI= 0.99–1.54); for HDL-c and low birthweight, 0.97 (0.73–1.28); for diastolic blood pressure and small-for-gestational-age, 0.98 (0.81–1.20); and for systolic blood pressure and small-for-gestational-age, 1.18 (0.97–1.45). High lipid levels before pregnancy predict an increased risk of pre-eclampsia and gestational diabetes. Reported associations between these pregnancy complications and later cardiovascular disease of the mother are probably explained, at least in part, by maternal conditions that precede pregnancy. Interventions to improve cardiovascular health before pregnancy may reduce risk of pregnancy complications.