Associations of gestational cardiovascular health with pregnancy outcomes: the Hyperglycemia and Adverse Pregnancy Outcome study.
Associations of gestational cardiovascular health with pregnancy outcomes: the Hyperglycemia and Adverse Pregnancy Outcome study.
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妊娠心血管健康与妊娠结局的关联：高血糖和不良妊娠结局研究。
DOI：
10.1016/j.ajog.2020.07.053
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发表时间：
2021-03
影响因子：
9.8
通讯作者：
Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group
中科院分区：
文献类型：
--
作者：
Perak AM;Lancki N;Kuang A;Labarthe DR;Allen NB;Shah SH;Lowe LP;Grobman WA;Scholtens DM;Lloyd-Jones DM;Lowe WL Jr;Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group
美国心脏协会对“心血管健康”的正式描述将多个指标结合在一个以健康为导向的框架中，而不是以疾病为导向的框架中。尽管建议在怀孕期间进行心血管健康评估，但其对妊娠结局的意义尚不清楚。本研究的目的是检查妊娠期心血管健康（正式由五个指标的组合来表征）与不良孕产妇和新生儿结局之间的关系。我们分析了高血糖和不良妊娠结局研究的数据，其中包括来自 6 个国家的 2,304 名母亲和新生儿。孕产妇心血管健康是通过平均妊娠 28 (24-32) 周测量的五项指标的组合来定义的：体重指数、血压、血脂、血糖和吸烟。使用怀孕指南对每个指标的水平进行分类，并对总体心血管健康状况进行评分（0-10 分；10 分最有利）。在分娩时收集脐带血，在 72 小时内测量新生儿的人体测量数据，并提取医疗记录以了解产科结果。采用改良泊松和多项逻辑回归来测试妊娠心血管健康与妊娠结局的关联，并根据中心、孕产妇和新生儿特征进行调整。女性平均年龄 29.6 岁，平均胎龄 39.8 周。妊娠期心血管健康平均总分为 8.6（满分 10 分）； 36.3% 的指标全部理想，7.5% 的指标有 2 个以上较差。在完全调整的模型中，心血管健康评分每高 1 分（更有利），与先兆子痫（相对风险 0.67 [95% 置信区间，0.61–0.73]）、计划外初次剖宫产（0.88 [0.82–0.95]）和新生儿出生体重>90%（0.81 [0.75–0.87]）、皮褶总和的风险降低相关。 >90% (0.84 [0.77–0.92])，胰岛素敏感性 <10% (0.83 [0.77–0.90])。心血管健康类别与结果存在分级关联；例如，对于具有 1+ 中等、1 较差或 2+ 较差（相对于所有理想）指标的女性，先兆子痫的相对风险（95% 置信区间）分别为 3.13 (1.39–7.06)、5.34 (2.44–11.70) 和 9.30 (3.95–21.86)。在一项跨国队列研究中，妊娠 24-32 周时更有利的心血管健康状况与多种不良妊娠结局的风险降低相关。
The American Heart Association’s formal characterization of “cardiovascular health” combines several metrics in a health-oriented, rather than disease-oriented, framework. Although cardiovascular health assessment during pregnancy has been recommended, its significance for pregnancy outcomes is unknown. The purpose of this study was to examine the association of gestational cardiovascular health—formally characterized by a combination of five metrics—with adverse maternal and newborn outcomes. We analyzed data from the Hyperglycemia and Adverse Pregnancy Outcome Study, including 2,304 mother-newborn dyads from six countries. Maternal cardiovascular health was defined by the combination of five metrics measured at a mean of 28 (24–32) weeks’ gestation: body mass index, blood pressure, lipids, glucose, and smoking. Levels of each metric were categorized using pregnancy guidelines, and total cardiovascular health was scored (0–10 points; 10 most favorable). Cord blood was collected at delivery, newborn anthropometrics were measured within 72 hours, and medical records were abstracted for obstetric outcomes. Modified Poisson and multinomial logistic regression were utilized to test associations of gestational cardiovascular health with pregnancy outcomes, adjusted for center and maternal and newborn characteristics. Women averaged 29.6 years old and delivered at a mean gestational age of 39.8 weeks. The mean total gestational cardiovascular health score was 8.6 (of 10); 36.3% had all ideal metrics and 7.5% had 2+ poor metrics. In fully adjusted models, each 1 point higher (more favorable) cardiovascular health score was associated with lower risks for preeclampsia (relative risk 0.67 [95% confidence interval, 0.61–0.73]), unplanned primary cesarean section (0.88 [0.82–0.95]), and newborn birthweight >90th percentile (0.81 [0.75–0.87]), sum of skinfolds >90th percentile (0.84 [0.77–0.92]), and insulin sensitivity <10th percentile (0.83 [0.77–0.90]). Cardiovascular health categories demonstrated graded associations with outcomes; for example, relative risks (95% confidence intervals) for preeclampsia were 3.13 (1.39–7.06), 5.34 (2.44–11.70), and 9.30 (3.95–21.86) for women with 1+ intermediate, 1 poor, or 2+ poor (versus all ideal) metrics, respectively. More favorable cardiovascular health at 24–32 weeks’ gestation was associated with lower risks for several adverse pregnancy outcomes in a multinational cohort.
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DOI：
10.1111/1471-0528.12375
发表时间：
2013-10-01
影响因子：
5.8
作者：
Gallos, I. D.;Sivakumar, K.;Vatish, M.
通讯作者：
Vatish, M.
影响因子：
7.2
作者：
通讯作者：
--
DOI：
10.1111/j.1471-0528.2009.02486.x
发表时间：
2010-04-01
影响因子：
5.8
作者：
Metzger, B. E.
通讯作者：
Metzger, B. E.
影响因子：
7.7
作者：
HAPO Study Cooperative Research Group
通讯作者：
HAPO Study Cooperative Research Group
影响因子：
9.8
作者：
Dr Yogev;Dr Chen;Dr Rogers
通讯作者：
Dr Rogers