Department of Epidemiology, Tulane University School of Public Health, New Orleans, LA, USA.
Epidemiology. 2011 Sep;22(5):724-30. doi: 10.1097/EDE.0b013e318225c960.
Pregnancy-related cardiovascular conditions are associated with both poorer pregnancy outcomes and cardiovascular disease later in life. Little is known about the relationship between preconception cardiovascular risk factor levels and pregnancy complications.
Data from the Cardiovascular Risk in Young Finns Study were linked with birth registry data for 1142 primiparous women. Age-standardized levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, insulin, and glucose from the study visit prior to last menstrual period were calculated. These factors were examined as predictors of gestational age, preterm birth (<37 weeks), birthweight, low birthweight (<2500 g), small-for-gestational-age (weight <10th percentile for gestational age), hypertensive disorders of pregnancy, and gestational diabetes, using linear and Poisson regression with adjustment for age, body mass index, smoking, and socioeconomic status.
Higher triglycerides were associated with a higher risk of hypertensive disorders (adjusted risk ratio [aRR] = 1.42 [95% confidence interval (CI) = 0.90-2.23]), preeclampsia (1.70 [1.08-2.65]), and gestational diabetes (1.68 [1.25-2.25]). After removing women with pregnancy complications (n = 30), the estimated aRR for the association between systolic blood pressure and preterm birth was 1.23 (95% CI = 0.99-1.54); for HDL-c and low birthweight, 0.97 (0.73-1.28); for diastolic blood pressure and small-for-gestational-age, 0.98 (0.81-1.20); and for systolic blood pressure and small-for-gestational-age, 1.18 (0.97-1.45).
High lipid levels before pregnancy predict an increased risk of preeclampsia and gestational diabetes. Reported associations between these pregnancy complications and later cardiovascular disease of the mother are probably explained, at least in part, by maternal conditions that precede pregnancy. Interventions to improve cardiovascular health before pregnancy may reduce risk of pregnancy complications.
与妊娠相关的心血管疾病不仅与妊娠结局较差有关，而且与日后发生心血管疾病有关。关于孕前心血管危险因素水平与妊娠并发症之间的关系知之甚少。
将来自心血管风险在年轻芬兰人中的研究的数据与出生登记数据进行了链接，共涉及 1142 名初产妇。根据末次月经前的研究访问中计算出总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、血压、胰岛素和葡萄糖的年龄标准化水平。使用线性和泊松回归，调整年龄、体重指数、吸烟和社会经济地位后，这些因素被作为妊娠年龄、早产（<37 周）、出生体重、低出生体重（<2500 克）、小于胎龄儿（体重<胎龄第 10 百分位）、妊娠高血压疾病和妊娠糖尿病的预测因子进行了研究。
较高的甘油三酯与妊娠高血压疾病（调整后的风险比[aRR] = 1.42 [95%置信区间[CI] = 0.90-2.23]）、子痫前期（1.70 [1.08-2.65]）和妊娠糖尿病（1.68 [1.25-2.25]）的风险增加相关。在排除了有妊娠并发症的女性（n = 30）后，收缩压与早产之间的关联的估计 aRR 为 1.23（95%CI = 0.99-1.54）；对于高密度脂蛋白胆固醇和低出生体重，为 0.97（0.73-1.28）；对于舒张压和小于胎龄儿，为 0.98（0.81-1.20）；对于收缩压和小于胎龄儿，为 1.18（0.97-1.45）。
妊娠前的高血脂水平预示着子痫前期和妊娠糖尿病的风险增加。这些妊娠并发症与母亲日后发生心血管疾病之间的报告关联可能至少部分归因于妊娠前的母体状况。在妊娠前改善心血管健康的干预措施可能会降低妊娠并发症的风险。
