From the Departments of Public Health, Norwegian University of Science and Technology, Trondheim, Norway; Social Medicine, University of Bristol, Bristol, United Kingdom; and Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.
Obstet Gynecol. 2009 Nov;114(5):961-970. doi: 10.1097/AOG.0b013e3181bb0dfc.
To study the association of hypertensive pregnancy disorders with modifiable risk factors for cardiovascular and metabolic diseases and to estimate the feasibility for early detection and prevention.
This was a prospective study of 15,065 women with a first singleton birth between 1967 and 1995, who later participated in a population study that included standardized measurements of blood pressure, serum lipids, and body mass index (BMI).
Women with a history of hypertensive disorders in pregnancy (preeclampsia or gestational hypertension) had higher BMI, higher blood pressure, and unfavorable levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides. Preeclampsia was associated with substantially higher risk of developing diabetes (odds ratio 3.8, 95% confidence interval [CI] 2.1-6.6), and if the hypertensive disorder occurred in more than one pregnancy, or in a relatively late pregnancy, the associations with later cardiovascular risk factors were substantially stronger. Thus, women with two episodes of preeclampsia were approximately 10 times more likely to use blood pressure medication at follow-up (adjusted odds ratio, 11.6, 95% CI 7.1-26.3), and in women with gestational hypertension in three consecutive pregnancies, systolic pressure was on average 27 mm Hg (95% CI 18-37 mm Hg) higher, and diastolic pressure was 12 mm Hg (95% CI 5-19 mm Hg) higher, compared with women without a history of hypertensive disorders. Adjustment for current body mass index partly attenuated these associations, suggesting that BMI may play an important mediating role.
Women with a history of hypertensive disorders in pregnancy, and particularly women with recurrent pregnancy disorders, should be candidates for intervention intended to prevent premature cardiovascular disease.
II.
研究妊娠高血压疾病与心血管和代谢疾病的可改变危险因素之间的关系，并评估早期检测和预防的可行性。
这是一项对 1967 年至 1995 年间首次单胎分娩的 15065 名女性进行的前瞻性研究，这些女性后来参加了一项人群研究，其中包括血压、血清脂质和体重指数（BMI）的标准化测量。
患有妊娠高血压疾病（子痫前期或妊娠期高血压）的女性 BMI 较高，血压较高，总胆固醇、低密度脂蛋白胆固醇和甘油三酯水平也不理想。子痫前期与糖尿病的发病风险显著增加相关（比值比 3.8，95%置信区间 [CI] 2.1-6.6），如果高血压疾病发生在一次以上妊娠或相对较晚的妊娠中，与以后心血管危险因素的相关性则更强。因此，两次子痫前期发作的女性在随访时更有可能使用降压药物（调整比值比，11.6，95%CI 7.1-26.3），而在连续三次妊娠中患有妊娠期高血压的女性中，收缩压平均升高 27mmHg（95%CI 18-37mmHg），舒张压升高 12mmHg（95%CI 5-19mmHg），与无妊娠高血压疾病史的女性相比。调整当前体重指数后，这些关联有所减弱，表明 BMI 可能起着重要的中介作用。
患有妊娠高血压疾病史的女性，尤其是患有反复妊娠疾病的女性，应成为预防早发性心血管疾病干预的候选者。
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