Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions?
Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions?
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DOI：
10.1016/j.ajog.2005.10.813
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发表时间：
2006-04-01
影响因子：
9.8
通讯作者：
Kramer, M
中科院分区：
文献类型：
--
作者：
Villar, J;Carroli, G;Kramer, M
目的：先兆子痫、妊娠期高血压和不明原因的胎儿宫内生长受限可能具有相似的决定因素和后果。在这项研究中，我们比较了与这些产科条件相关的决定因素和围产期结局。研究设计：我们分析了39,615例妊娠（数据来自WHO产前护理试验），其中2.2%并发先兆子痫，7.0%并发妊娠高血压，8.1%并发不明原因的宫内生长受限（即与母亲吸烟、母亲营养不良、先兆子痫、妊娠期高血压或先天性畸形无关）。我们比较了与这些组相关的风险因素。胎儿死亡、早产和严重新生儿发病率和死亡率是主要结局。Logistic回归分析调整研究地点，社会经济地位，（如果合适的话）出生体重和gestational age.Results：糖尿病，肾脏或心脏疾病，以前的先兆子痫，尿路感染，高产妇年龄，双胎妊娠，肥胖的风险增加这两种高血压疾病。高龄分娩史、生殖道手术史、产前出血和生殖道感染仅增加妊娠期高血压的风险。独立于母亲年龄，重复产次仅是先兆子痫的危险因素。先兆子痫和妊娠期高血压均与胎儿死亡和严重新生儿发病率和死亡率的风险增加相关。与原因不明的宫内生长受限的母亲相比，先兆子痫的母亲更可能有糖尿病、肾脏或心脏病、慢性高血压、既往先兆子痫、体重指数> 30 kg/cm 2、尿路感染和母亲年龄过大的病史。相反，不明原因的宫内生长受限与既往妊娠低出生体重的风险较高相关，但与既往先兆子痫无关。这两种情况增加了围产期结局的风险独立，但先兆子痫与相当高的risk.Conclusion：先兆子痫和妊娠期高血压共享许多危险因素，虽然有差异，需要进一步评估。这两种情况都显著增加了发病率和死亡率。相反，先兆子痫和不明原因的宫内生长受限，通常被认为与胎盘功能不全有关，似乎是独立的生物学实体。(C)2006 Mosby，Inc. All rights reserved.
Objective: Preeclampsia, gestational hypertension, and unexplained intrauterine growth restriction may have similar determinants and consequences. In this study, we compared determinants and perinatal outcomes associated with these obstetric conditions.Study design: We analyzed 39,615 pregnancies (data from the WHO Antenatal Care Trial), of which 2.2% were complicated by preeclampsia, 7.0% by gestational hypertension, and 8.1% by unexplained intrauterine growth restriction (ie, not associated with maternal smoking, maternal undernutrition, preeclampsia, gestational hypertension, or congenital malformations). We compared the risk factors associated with these groups. Fetal death, preterm delivery, and severe neonatal morbidity and mortality were the primary outcomes. Logistic regression analyses were adjusted for study site, socioeconomic status, and (if appropriate) birth weight and gestational age.Results: Diabetes, renal or cardiac disease, previous preeclampsia, urinary tract infection, high maternal age, twin pregnancy, and obesity increased the risk of both hypertensive conditions. Previous large-for-age birth, reproductive tract surgery, antepartum hemorrhage and reproductive tract infection increased the risk for gestational hypertension only. Independent of maternal age, primiparity was a risk factor only for preeclampsia. Both preeclampsia and gestational hypertension were associated with increased risk for fetal death and severe neonatal morbidity and mortality. Mothers with preeclampsia compared with those with unexplained intrauterine growth restriction were more likely to have a history of diabetes, renal or cardiac disease, chronic hypertension, previous preeclampsia, body mass index more than 30 kg/cm(2) urinary tract infection and extremes of maternal age. Conversely, unexplained intrauterine growth restriction was associated with higher risk of low birth weight in previous pregnancies, but not with previous preeclampsia. Both conditions increased the risk for perinatal outcomes independently but preeclampsia was associated with considerable higher risk.Conclusion: Preeclampsia and gestational hypertension shared many risk factors, although there are differences that need further evaluation. Both conditions significantly increased morbidity and mortality. Conversely, preeclampsia and unexplained intrauterine growth restriction, often assumed to be related to placental insufficiency, seem to be independent biologic entities. (C) 2006 Mosby, Inc. All rights reserved.