Placenta Accreta Spectrum and Hypertensive Disorders of Pregnancy: Concerns Regarding the Difference in Length of Pregnancy
Placenta Accreta Spectrum and Hypertensive Disorders of Pregnancy: Concerns Regarding the Difference in Length of Pregnancy
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植入性胎盘谱系与妊娠期高血压疾病：对妊娠时长差异的担忧
DOI：
10.1007/s43032-022-01043-5
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发表时间：
2022
影响因子：
2.9
通讯作者：
Kamiura Shoji
中科院分区：
文献类型：
--
作者：
Matsuzaki Shinya;Hayashida Harue;Kamiura Shoji
我们怀着极大的兴趣阅读了玲莉等人的文章，关于胎盘植入谱（PAS）妇女中妊娠期高血压疾病（HDP）的患病率[1]。这项系统性综述确定了4项研究（47，353名孕妇; 4，283名HDP女性和493名PAS女性），检查并比较了有和没有PAS的女性之间的HDP患病率。在未校正的汇总分析中（n= 4），PAS女性发生HDP的可能性低于无PAS女性（比值比[OR]，0.59，95%置信区间[CI] 0.38-0.94，P= 0.03）。此外，研究人员观察到，与未患PAS的女性相比，患HDP的女性患PAS的可能性较小（OR 0.60，95% CI 0.38-0.94，P= 0.03）。因此，他们认为较短的妊娠期可能导致PAS女性HDP的患病率较低。由于高血压可能导致血管内皮损伤并额外影响胎盘植入，研究者认为，HDP妇女中异常滋养层子宫浸润导致HDP妇女PAS患病率较低。本研究的结果是有趣的，讨论有助于理解HDP和PAS之间的负相关关系。然而，必须确定一些重要的混杂因素。最近，我们使用2015年10月至2017年12月的全国住院患者样本，检查了因PAS接受剖宫产（CD）的女性的人群趋势、特征和手术结局[2]。在这项研究中，包括2，727，477名在研究期间接受CD的女性，8，030名（0.29%）被诊断为PAS。在PAS患者中，胎盘植入是最常见的诊断（n= 6，205，0.23%），其次是胎盘植入（n= 1，060，0.04%）和植入（n= 765，0.03%）。本研究的优势在于纳入的孕妇数量;然而，需要认识到以下突出的局限性：（i）仅纳入接受CD的女性;（ii）由于PAS和HDP的诊断是使用ICD-10代码进行的，因此诊断的准确性未知;（iii）无法获得产次数量。考虑到一些值得注意的局限性，我们认为我们的研究结果在检查PAS对HDP患病率的影响方面是有用的。在这项研究中，根据PAS确定了患者的特征，HDP的患病率为14.2%（386，105/2，719，448），胎盘植入女性为12.5%（775/6205），胎盘植入女性为8.5%（65/765），胎盘植入女性为7.5%（80/1060）（表1）。在多项逻辑回归模型中进行分析（未校正孕周），HDP的校正比值比（aOR）如下：胎盘植入与非PAS（aOR 0.83，95% CI 0.77-0.91），胎盘植入vs非PAS（aOR 0.43，95% CI 0.32-0.57），胎盘植入与非PAS（aOR 0.49，95% CI 0.39-0.62）。这些结果表明，PAS女性比没有PAS的女性更不可能发展HDP，这与Lingli等人的研究结果一致。然而，尽管妊娠时间是HDP检查中的一个重要患者特征，我们的研究和Lingli等人的研究都没有排除有PAS和无PAS的妇女之间妊娠时间的差异作为混杂因素[1-3]。我们先前研究的结果见表1。在我们以前的研究中，无PAS的妇女分娩时的中位孕周为39周（四分位距[IQR] 38-39），有PAS的妇女分娩时的中位孕周为39周（四分位距[IQR] 38-39）。
We read with great interest the article by Lingli et al., regarding the prevalence of hypertensive disorders of pregnancy (HDP) among women with placenta accreta spectrum (PAS)[1]. This systematic review identified 4 studies (47,353 pregnant women; 4,283 women with HDP and 493 women with PAS) that examined and compared the rate of HDP prevalence between women with and without PAS. In the unadjusted pooled analysis (n= 4), women with PAS were less likely to develop HDP than those without PAS (odds ratio [OR], 0.59, 95% confidence interval [CI] 0.38–0.94, P= 0.03). In addition, the investigators observed that women who developed HDP were less likely to have PAS compared to the women without PAS (OR 0.60, 95% CI 0.38–0.94, P= 0.03). Therefore, they suggested that a shorter length of pregnancy may lead to a low prevalence of HDP in women with PAS. Because hypertension might cause vascular endothelial injury and additionally affect placental implantation, the investigators considered that abnormal trophoblastic uterine invasion in women who developed HDP led to the low prevalence of PAS in women who developed HDP. The results of this study are interesting, and the discussion is useful for understanding the negative relationship between HDP and PAS. Nevertheless, some important confounding factors must be identified. Recently, we examined the population-based trends, characteristics, and surgical outcomes of women who underwent cesarean delivery (CD) for PAS using the National Inpatient Sample from October 2015 to December 2017 [2]. In this study, including 2,727,477 women who underwent CD during the study period, 8,030 (0.29%) were diagnosed with PAS. Among women with PAS, placenta accreta was the most common diagnosis (n= 6,205, 0.23%), followed by placenta percreta (n= 1,060, 0.04%) and increta (n= 765, 0.03%). The strength of this study is the number of included pregnant women; however, the following salient limitations need to be recognized:(i) only women who underwent CD were included;(ii) since the diagnoses of PAS and HDP were performed by using ICD-10 code, the accuracy of diagnosis is unknown; and (iii) the number of parity was unavailable. Considering some notable limitations, we believe that the results of our study are useful in examining the effect of PAS on the prevalence of HDP.In this study, patient characteristics per PAS were determined, and the prevalence rates of HDP were 14.2%(386,105/2,719,448) in women without PAS, 12.5%(775/6205) in women with placenta accreta, 8.5%(65/765) in women with placenta increta, and 7.5%(80/1060) in women with placenta percreta (Table 1). In a multinomial logistic regression model for analysis (not adjusted for gestational weeks), the adjusted odds ratios (aOR) of HDP were as follows: placenta accreta versus non-PAS (aOR 0.83, 95% CI 0.77–0.91), placenta increta versus non-PAS (aOR 0.43, 95% CI 0.32–0.57), and placenta percreta versus non-PAS (aOR 0.49, 95% CI 0.39–0.62). These results suggest that women with PAS were less likely to develop HDP than those without PAS, which is consistent with the results of a study by Lingli et al. However, although the length of pregnancy is an essential patient characteristic in the examination of HDP, both our study and the one by Lingli et al. did not exclude the difference in length of pregnancy between women with and without PAS as a confounding factor [1–3]. The results of our previous study are presented in Table 1. In our previous study, the median gestational weeks at delivery for women without PAS were 39 weeks (interquartile range [IQR] 38–39), women with …