Hypertensive disorders first identified in pregnancy increase risk for incident prehypertension and hypertension in the year after delivery
Hypertensive disorders first identified in pregnancy increase risk for incident prehypertension and hypertension in the year after delivery
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DOI：
10.1097/hjh.0000000000000855
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发表时间：
2016-04-01
影响因子：
4.9
通讯作者：
Reynolds, Kristi
中科院分区：
文献类型：
--
作者：
Black, Mary Helen;Zhou, Hui;Reynolds, Kristi
背景：妊娠期高血压疾病，包括先兆子痫/子痫(PE/E)，与心血管疾病的长期风险相关。然而，这些情况对产后早期高血压前期(PreHTN)或高血压(HTN)风险的影响知之甚少。方法：队列包括2005-2010年间在Kaiser Permanente Bell Flow医学中心接受产前护理并生下一名活体单胎新生儿的妇女。患有孕前HTN或孕前HTN的妇女被排除在分析之外。结果：在5960名孕前血压正常的妇女中，358名(6.0%)在孕期发生高血压疾病，其中215名(60.1%)患有PE/E，其中215名(60.1%)在产后一年内发生高血压病，总体而言，63名(1.1%)在产后一年发生HTN和902名(15.1%)孕前HTN。在考虑了所有可能的混杂因素后，妊娠期高血压疾病患者和PE/E患者在产后一年发生HTN前期/HTN的可能性分别是非妊娠期HTN患者的2.36倍(95%可信区间：1.97~2.83)和2.48倍(95%可信区间：1.99~3.11)。对妊娠期糖尿病进行调整前后的结果相似。结论：我们的研究结果强调了前瞻性研究的必要性，目的是确定产后早期筛查和改善对首次发现的妊娠期高血压疾病的随访是否可以预防未来的心血管疾病。
Background:Hypertensive disorders in pregnancy, including preeclampsia/eclampsia (PE/E) are associated with long-term cardiovascular disease risk. However, little is known about the effect of these conditions on risk for prehypertension (preHTN) or hypertension (HTN) in the early years after delivery.Methods:The cohort consisted of women who had prenatal care and delivered a live singleton neonate at Kaiser Permanente Bellflower Medical Center in 2005-2010. Women with prepregnancy HTN or preHTN were excluded from analysis. Multivariable robust Poisson regression models were used to assess associations between any hypertensive disorder or PE/E and development of preHTN/HTN in the year after delivery, adjusted for maternal age, race/ethnicity, parity, smoking, prepregnancy weight status, gestational weight gain, gestational diabetes, and gestational age.Results:Among 5960 women who were normotensive prior to pregnancy, 358 (6.0%) developed a hypertensive disorder in pregnancy, of whom 215 (60.1%) had PE/E. Overall, 63 (1.1%) developed HTN and 902 (15.1%) preHTN in the year after delivery. After accounting for all potential confounders, women with a hypertensive disorder in pregnancy and those with PE/E were 2.36 (95% confidence interval: 1.97-2.83) and 2.48 (95% confidence interval: 1.99-3.11) times as likely, respectively, to develop preHTN/HTN in the year after delivery as those without pregnancy-related HTN. Results were similar with and without adjustment for gestational diabetes.Conclusion:Our findings highlight the need for prospective studies aimed at determining whether early postpartum screening and improved follow-up of women with hypertensive disorders first identified in pregnancy may prevent future cardiovascular disease.