Ananth Cande V, Peltier Morgan R, Kinzler Wendy L, Smulian John C, Vintzileos Anthony M
Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901-1977, USA.
Am J Obstet Gynecol. 2007 Sep;197(3):273.e1-7. doi: 10.1016/j.ajog.2007.05.047.
The purpose of this study was to evaluate whether the increased risk of placental abruption among women with chronic hypertension is modified by ischemic placental disease, specifically pregnancy-induced hypertension (PIH) and fetal growth restriction (FGR).
We used the US linked natality and fetal death data files (1995-2002) and restricted the analysis to women who had a singleton birth at > or = 22 weeks of gestation and to fetuses who weighed > or = 500 g (n = 30,189,949). Fetal growth was defined both on a continuum (<1, 1-2, 3-4, 5-9, 10-19, ..., > or = 90) and as birthweight of < 10th percentile for gestational age (FGR) or birthweight of > 90th percentile (large for gestational age [LGA]). All analyses were adjusted for potential confounding factors through multivariable logistic regression.
Rates of abruption among women with and without chronic hypertension were 15.6 and 5.8 per 1000 pregnancies, respectively (relative risk [RR], 2.4; 95% CI, 2.3, 2.5). In comparison with normotensive women with appropriately grown babies (ie, 10th-90th percentile), the association between chronic hypertension and abruption was modified in the presence of FGR (RR, 3.8; 95% CI, 3.6, 4.1) and PIH (RR, 7.7; 95% CI, 6.6, 8.9). However, the highest risk was seen among women with chronic hypertension, PIH, and LGA (RR, 9.0; 95% CI, 7.2, 11.3). A dose-response relationship was observed between the risk of abruption and fetal growth (assessed on a continuum), with the risk being lowest among LGA babies.
The association between chronic hypertension and abruption is strong; ischemic placental disease (PIH and FGR) modified this relationship. These findings suggest an etiologic relationship between abruption and chronic placental disease. Chronic hypertension, if associated with LGA, is not associated with abruption; however, chronic hypertension with superimposed PIH accompanied by LGA is associated with significantly increased risk.
本研究的目的是评估慢性高血压女性胎盘早剥风险的增加是否会因缺血性胎盘疾病而改变，特别是妊娠高血压（PIH）和胎儿生长受限（FGR）。
我们使用了美国出生与胎儿死亡数据关联文件（1995 - 2002年），并将分析限制在妊娠≥22周单胎分娩的女性以及体重≥500克的胎儿（n = 30189949）。胎儿生长情况既根据连续数据（<1、1 - 2、3 - 4、5 - 9、10 - 19、……、≥90）来定义，也根据胎龄体重低于第10百分位数（FGR）或高于第90百分位数（大于胎龄[LGA]）来定义。所有分析通过多变量逻辑回归对潜在混杂因素进行了校正。
有和没有慢性高血压的女性胎盘早剥发生率分别为每1000次妊娠15.6例和5.8例（相对风险[RR]，2.4；95%可信区间[CI]，2.3，2.5）。与血压正常且胎儿生长适宜（即第10 - 90百分位数）的女性相比，在存在FGR（RR，3.8；95%CI，3.6，4.1）和PIH（RR，7.7；95%CI，6.6，8.9）的情况下，慢性高血压与胎盘早剥之间的关联发生了改变。然而，慢性高血压、PIH和LGA的女性风险最高（RR，9.0；95%CI，7.2，11.3）。观察到胎盘早剥风险与胎儿生长（根据连续数据评估）之间存在剂量反应关系，LGA婴儿的风险最低。
慢性高血压与胎盘早剥之间的关联很强；缺血性胎盘疾病（PIH和FGR）改变了这种关系。这些发现提示了胎盘早剥与慢性胎盘疾病之间的病因学关系。慢性高血压若与LGA相关，则与胎盘早剥无关；然而，伴有LGA的慢性高血压合并PIH则与显著增加的风险相关。
