Comparison of risk factors and perinatal outcomes in early onset and late onset preeclampsia: A cohort based study in Reunion Island
Comparison of risk factors and perinatal outcomes in early onset and late onset preeclampsia: A cohort based study in Reunion Island
复制标题
DOI：
10.1016/j.jri.2017.08.005
复制
发表时间：
2017-09-01
影响因子：
3.4
通讯作者：
Robillard, Pierre-Yves
中科院分区：
文献类型：
--
作者：
Iacobelli, Silvia;Bonsante, Francesco;Robillard, Pierre-Yves
本研究对留尼旺岛15年（2001-2015年；N = 62230例妊娠）妇女队列中合并早发型（分娩< 34周）和晚发型（分娩34周）先兆子痫的临床差异、孕产妇危险因素和妊娠结局进行了研究。单胎妊娠总子痫前期率为2.37%。早发性和晚发性子痫前期患病率分别为0.75%和1.5%，各类型疾病的趋势稳定。在这两种形式的先兆子痫中，怀孕期间吸烟是一个保护因素，相关的危险因素是：年龄较大、初产、既往糖尿病、慢性高血压、较高的孕前体重指数和肥胖、不孕症治疗、肾脏疾病史和高胆固醇血症（均p < 0.05）。子痫前期妇女的剖宫产率、药物引产率以及胎儿和新生儿预后受损率均显著高于对照组（均p < 0.0001）。当比较早发型子痫前期与晚发型子痫前期时，唯一的区别是早发型子痫前期产妇的年龄较大（p = 0.02），两组子痫前期妇女在产妇危险因素方面相似，除了早发型子痫前期慢性高血压的发生率较高（p = 0.02）。在调整分娩时胎龄后，对胎儿和新生儿结局进行了评估，在早发性和晚发性子痫前期妇女之间没有发现差异。这些分析未能确定特定表型的先兆子痫的易感性或预先存在的危险因素的一种形式或另一种。分娩时胎龄是影响后代结局的最重要因素。
Clinical differences, maternal risk factors and pregnancy outcomes of deliveries complicated by early- (delivery < 34 weeks) and late-onset (delivery 34 weeks) preeclampsia were studied in a cohort of women in Reunion Island during 15 years (period 2001-2015; N = 62,230 pregnancies). The overall preeclampsia rate in singleton pregnancies was 2.37%. Early- and late-onset preeclampsia rates were 0.75% and 1.5% respectively, and the trend for each type of disease was stable over lime. In both form of preeclampsia, smoking during pregnancy was a protective factor and associated risk factors were: older age, primiparity, pre-existing diabetes, chronic hypertension, higher pre-pregnancy body mass index and obesity, infertility treatment, history of renal disease and hypercholesterolemia (all p < 0.05). The rate of caesarean section, medically-induced delivery and impaired foetal and neonatal outcomes were significantly higher in preeclamptic women (all p < 0.0001). When comparing early- versus late-onset preeclampsia, the only difference was the older maternal age in primiparae with early-onset preeclampsia (p = 0.02), and the two groups of preeclamptic women were similar in terms of maternal risk factors, with the exception of higher rates of chronic hypertension in early-onset preeclampsia (p = 0.02). Foetal and neonatal outcomes were evaluated after adjustment for gestational age at delivery and no difference was detected between early- and late-onset preeclamptic women. These analyses failed to identify a specific phenotype of preeclampsia in terms of predisposition or pre-existing risk factors for one form or another. Gestational age at delivery was the most important predictor for offspring outcome.