Chappell Lucy C, Enye Stephen, Seed Paul, Briley Annette L, Poston Lucilla, Shennan Andrew H
Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College London School of Biomedical and Health Sciences, London SE1 7EH, UK.
Hypertension. 2008 Apr;51(4):1002-9. doi: 10.1161/HYPERTENSIONAHA.107.107565. Epub 2008 Feb 7.
Prospective contemporaneous data on the outcome of pregnancies in women with chronic hypertension are sparse. Indices of maternal and perinatal morbidity and mortality were determined in 822 women with chronic hypertension with data prospectively collected and rigorously validated. The incidence of superimposed preeclampsia was 22% (n=180) with early-onset preeclampsia (<or=34 weeks gestation) accounting for nearly half of these cases. Delivering an infant <10th customized birthweight centile complicated 48% (87/180) of those with superimposed preeclampsia and 21% (137/642) in those without (relative risk [RR] 2.30; 95% confidence intervals [CI] 1.85 to 2.84). Delivery at <37 weeks gestation occurred in 51% of those with superimposed preeclampsia (98% of these iatrogenic) and 15% without (66% iatrogenic) (RR 3.52; 95% CI 2.79 to 4.45). Using multiple logistic regression, black ethnic origin, raised body mass index, present smoking, booking systolic blood pressure of 130 to 139 mm Hg, and diastolic blood pressure of 80 to 89 mm Hg, a previous history of preeclampsia or eclampsia and chronic renal disease were identified as risk factors for superimposed preeclampsia. Adverse maternal and perinatal outcomes occur in women with chronic hypertension; the prevalence of infants born small for gestational age and preterm is considerably higher than background rates, and is increased further in women with superimposed preeclampsia. Use of customized birthweight centiles provides more accurate determination of fetal growth restriction and highlights the need for greater fetal surveillance in these women. Paradoxically, smoking is an independent risk factor for superimposed preeclampsia in chronic hypertension, in contrast to the protective effect in low-risk pregnant women.
关于慢性高血压女性妊娠结局的前瞻性同期数据稀少。对822例慢性高血压女性的孕产妇和围产期发病率及死亡率指标进行了测定，数据通过前瞻性收集并经过严格验证。并发子痫前期的发生率为22%（n = 180），其中早发型子痫前期（妊娠≤34周）占近一半病例。在并发子痫前期的患者中，出生体重低于第10定制百分位数的婴儿占48%（87/180），而未并发子痫前期的患者中这一比例为21%（137/642）（相对危险度[RR] 2.30；95%置信区间[CI] 1.85至2.84）。并发子痫前期的患者中，51%在妊娠<37周时分娩（其中98%为医源性），未并发子痫前期的患者中这一比例为15%（66%为医源性）（RR 3.52；95% CI 2.79至4.45）。通过多因素逻辑回归分析，确定黑人种族、体重指数升高、当前吸烟、孕早期收缩压130至139 mmHg、舒张压80至89 mmHg、子痫前期或子痫及慢性肾病病史为并发子痫前期的危险因素。慢性高血压女性会出现不良的孕产妇和围产期结局；小于胎龄儿和早产儿的患病率显著高于基线水平，并发子痫前期的女性中这一情况进一步加重。使用定制出生体重百分位数能更准确地确定胎儿生长受限情况，并凸显了对这些女性加强胎儿监测的必要性。矛盾的是，吸烟是慢性高血压并发子痫前期的独立危险因素，这与吸烟对低风险孕妇的保护作用相反。
