Pregnancy-Related Risk Factors Are Associated With a Significant Burden of Treated Hypertension Within 10 Years of Delivery: Findings From a Population-Based Norwegian Cohort.
Pregnancy-Related Risk Factors Are Associated With a Significant Burden of Treated Hypertension Within 10 Years of Delivery: Findings From a Population-Based Norwegian Cohort.
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DOI：
10.1161/jaha.117.008318
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发表时间：
2018-05-13
影响因子：
5.4
通讯作者：
Haugen M
中科院分区：
文献类型：
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作者：
Egeland GM;Skurtveit S;Staff AC;Eide GE;Daltveit AK;Klungsøyr K;Trogstad L;Magnus PM;Brantsæter AL;Haugen M
妊娠并发症和妇女以后的心血管疾病之间的关联主要是在缺乏重要协变量信息的研究中进行评估的。本报告评估了妊娠相关风险因素（先兆子痫/子痫、妊娠期高血压、妊娠前和妊娠期糖尿病、早产和胎儿生长受限）与妊娠后10年内接受过经皮冠状动脉造影治疗的高血压之间的前瞻性相关性，同时调整了广泛的协变量。将2004年1月至2009年7月参加MoBa（挪威母亲和儿童队列研究）的孕前血压正常的妇女与挪威处方数据库相关联，以确定产后3个月后接受非甾体类药物治疗的高血压妇女。使用归因分数法评估与妊娠相关危险因素相关的高血压负担。在60027名女性中，共有1480名女性在随访期间发生了接受药物治疗的高血压（高血压发生率为3.6/1000人年）。基于多变量分析调整了许多协变量，与先兆子痫/子痫、妊娠期高血压、早产和妊娠前或妊娠期糖尿病病史相关的高血压比例为28.6%（95%置信区间，25.5%-31.6%）。孕前体重指数健康的女性的比例相似（18.5 - 24.9 kg/m2;归因分数（AF）% 25.9%; 95%置信区间，21.3%-30.3%），但在随访的前5年内基线时未经产女性的比例明显较高。然而，在多变量分析中，小于胎龄并没有增加随后的高血压风险。通过妊娠相关风险因素确定的高风险女性的结构化产后随访将有助于个性化预防策略，以推迟或避免过早发生心血管事件。
The association between pregnancy complications and women's later cardiovascular disease has, primarily, been evaluated in studies lacking information on important covariates. This report evaluates the prospective associations between pregnancy‐related risk factors (preeclampsia/eclampsia, gestational hypertension, pregestational and gestational diabetes mellitus, preterm delivery, and fetal growth restriction) and pharmacologically treated hypertension within 10 years after pregnancy, while adjusting for a wide range of covariates. Prepregnancy normotensive women participating in the MoBa (Norwegian Mother and Child Cohort Study) from January 2004 through July 2009 were linked to the Norwegian Prescription Database to identify women with pharmacologically treated hypertension beyond the postpartum period of 3 months. The burden of hypertension associated with pregnancy‐related risk factors was evaluated using an attributable fraction method. A total of 1480 women developed pharmacologically treated hypertension within the follow‐up among 60 027 women (rate of hypertension, 3.6/1000 person‐years). The proportion of hypertension associated with a history of preeclampsia/eclampsia, gestational hypertension, preterm delivery, and pregestational or gestational diabetes mellitus was 28.6% (95% confidence interval, 25.5%–31.6%) on the basis of multivariable analyses adjusting for numerous covariates. The proportion was similar for women with a healthy prepregnancy body mass index (18.5‐24.9 kg/m2; attributable fraction (AF)% 25.9%; 95% confidence interval, 21.3%‐30.3%), but considerably higher for nulliparous women at baseline within the first 5 years of follow‐up. Small‐for‐gestational age, however, did not increase subsequent hypertension risk in multivariable analyses. A structured postpartum follow‐up of high‐risk women identified through pregnancy‐related risk factors would facilitate personalized preventive strategies to postpone or avoid onset of premature cardiovascular events.