The effects and mechanisms of primiparity on the risk of pre-eclampsia: a systematic review
The effects and mechanisms of primiparity on the risk of pre-eclampsia: a systematic review
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DOI：
10.1111/j.1365-3016.2007.00836.x
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发表时间：
2007-07-01
影响因子：
2.8
通讯作者：
Fraser, William D.
中科院分区：
文献类型：
--
作者：
Luo, Zhong-Cheng;An, Na;Fraser, William D.
先兆子痫被称为“初产疾病”。然而，初产与先兆子痫相关的影响和机制尚未明确。我们对评估初产对先兆子痫风险的影响的研究以及有关这种关联机制的研究（1966 年 1 月至 2005 年 7 月期间发表）进行了系统回顾。共确定了 26 项原始研究，并对初产妇与经产妇的先兆子痫风险进行了荟萃分析。在所有研究中，初产妇的先兆子痫风险均不同程度地较高（1.4-5.5 倍），总比值比 (OR) 为 2.42 [95% CI 2.16, 2.71]。除一项研究外，经过各种调整后，所有研究中调整后的 OR 均大于粗略 OR。除了支持免疫适应不良理论的大量流行病学证据外，只有四项原始研究探讨了这种初产相关风险的实际机制。两项（小型）研究表明，初产妇与经产妇的先兆子痫病因的免疫反应存在差异。最近的两项研究表明，妊娠早期血管生成因子谱或胰岛素抵抗反应性的差异可能解释了首次妊娠时先兆子痫风险升高的原因。总之，初产与先兆子痫风险增加约 2.4 倍相关。尽管免疫适应不良通常被认为是解释这种风险升高的基础，但关于初产和多产妊娠的免疫适应不良参数的数据很少。现有数据不足以解释这种与初产相关的先兆子痫风险过高的机制。
Pre-eclampsia has been dubbed as 'a disease of primiparity'. However, the effects and mechanisms of the association of primiparity with pre-eclampsia have not been clearly defined. We conducted a systematic review of studies evaluating the effect of primiparity on the risk of pre-eclampsia, and studies (published between January 1966 and July 2005) on the mechanisms underlying such an association. A total of 26 original studies were identified and a meta-analysis carried out for the risk of pre-eclampsia among primiparous vs. multiparous women.Variably (1.4-5.5 times) higher risks of pre-eclampsia were observed in primiparous women in all studies, with a summary odds ratio (OR) of 2.42 [95% CI 2.16, 2.71]. The adjusted ORs were larger than crude ORs in all but one study after various adjustments. Except for abundant epidemiological evidence in support of the immune maladaptation theory, only four original studies examined the actual mechanisms of such primiparity-associated risk. Two (small) studies suggested differences in immunological responses in the aetiology of pre-eclampsia in primiparous vs. multiparous women. Two recent studies indicated that differences in angiogenic factor profile or reactivity to insulin resistance in early pregnancy may explain the elevated pre-eclampsia risk in first pregnancies. In conclusion, primiparity is associated with approximately 2.4-fold elevated risk of pre-eclampsia. Although immune maladaptation is generally considered as the basis to explain such an elevated risk, few data are available on immune maladaptation parameters in primiparous vs. multiparous pregnancies. Available data are insufficient to interpret the mechanisms of such primiparity-associated excess risk of pre-eclampsia.