Hypertension in pregnancy and adverse outcomes among low-risk nulliparous women expectantly managed at or after 39 weeks: a secondary analysis of a randomised controlled trial.
Hypertension in pregnancy and adverse outcomes among low-risk nulliparous women expectantly managed at or after 39 weeks: a secondary analysis of a randomised controlled trial.
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DOI：
10.1111/1471-0528.17059
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2022-07
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目的：评估妊娠期低风险未生育患者（EM）在妊娠39周或之后的妊娠期高血压疾病（HDP）是否与不良结局相关。随机试验的二次分析。多中心的美国。EM组在39周或之后分娩的个体。多变量分析用于估计二项结果的调整相对风险（aRR）、多项结果的调整优势比（aOR）和95%置信区间（CI）。复合不良产妇结局包括胎盘早剥、肺水肿、产后出血、产后感染、静脉血栓栓塞或入住重症监护病房。次要结局包括围产期死亡或严重新生儿并发症、分娩方式、胎龄大小、新生儿中等或重症住院时间。在原始试验中随机分配到EM的3044例患者中，2718例（89.3%）符合该分析，其中373例（13.7%）发展为HDP。与保持血压正常的参与者相比，发生HDP的参与者更有可能经历产妇复合（12%对6%，aRR 1.84, 95% CI 1.33-2.54）和剖宫产（29%对23%，aOR 1.32, 95% CI 1.01-1.71）。两组在不良围产期综合情况（7% vs. 5%, aRR 1.38, 95% CI 0.92-2.07）或其他次要结局方面差异无显著性差异。几乎14%的低风险无产个体在39周时发生了HDP，与那些没有发生HDP的人相比，更有可能经历不良的产妇结局。Clinicaltrials.gov, www.clinicaltrials.gov, NCT01990612
To evaluate whether hypertensive disorders of pregnancy (HDP) among low-risk nulliparous people expectantly managed (EM) at or after 39 weeks of gestation are associated with adverse outcomes. Secondary analysis of a randomized trial. Multicenter United States. Individuals in the EM group who delivered on or after 39 weeks. Multivariable analysis to estimate adjusted relative risks (aRR) for binomial outcomes, adjusted odds ratios (aOR) for multinomial outcomes, and 95% confidence intervals (CI). Composite adverse maternal outcome including placental abruption, pulmonary edema, postpartum hemorrhage, postpartum infection, venous thromboembolism, or intensive care unit admission. Secondary outcomes included a composite of perinatal death or severe neonatal complications, mode of delivery, small and large for gestational age, and neonatal intermediate or intensive unit length of stay. Of the 3,044 randomized to EM in the original trial, 2,718 (89.3%) were eligible for this analysis, of whom 373 (13.7%) developed HDP. Compared with participants who remained normotensive, those who developed HDP were more likely to experience the maternal composite (12% vs. 6%, aRR 1.84, 95% CI 1.33–2.54) and cesarean delivery (29% vs. 23%, aOR 1.32, 95% CI 1.01–1.71). Differences between the two groups were not significantly different for the adverse perinatal composite (7% vs. 5%, aRR 1.38, 95% CI 0.92–2.07), or other secondary outcomes. Almost 14% of low-risk nulliparous individuals expectantly managed at 39 weeks developed HDP, and were more likely to experience adverse maternal outcomes compared with those who did not develop HDP. Clinicaltrials.gov, www.clinicaltrials.gov, NCT01990612