Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
BMJ. 2012 Nov 27;345:e7677. doi: 10.1136/bmj.e7677.
To assess the association of pre-eclampsia with later cardiovascular death in mothers according to their lifetime number of pregnancies, and particularly after only one child.
Prospective, population based cohort study.
Medical Birth Registry of Norway.
We followed 836,147 Norwegian women with a first singleton birth between 1967 and 2002 for cardiovascular mortality through linkage to the national Cause of Death Registry. About 23,000 women died by 2009, of whom 3891 died from cardiovascular causes. Associations between pre-eclampsia and cardiovascular death were assessed by hazard ratios, estimated by Cox regression analyses. Hazard ratios were adjusted for maternal education (three categories), maternal age at first birth, and year of first birth
The rate of cardiovascular mortality among women with preterm pre-eclampsia was 9.2% after having only one child, falling to 1.1% for those with two or more children. With term pre-eclampsia, the rates were 2.8% and 1.1%, respectively. Women with pre-eclampsia in their first pregnancy had higher rates of cardiovascular death than those who did not have the condition at first birth (adjusted hazard ratio 1.6 (95% confidence interval 1.4 to 2.0) after term pre-eclampsia; 3.7 (2.7 to 4.8) after preterm pre-eclampsia). Among women with only one lifetime pregnancy, the increase in risk of cardiovascular death was higher than for those with two or more children (3.4 (2.6 to 4.6) after term pre-eclampsia; 9.4 (6.5 to 13.7) after preterm pre-eclampsia). The risk of cardiovascular death was only moderately elevated among women with pre-eclamptic first pregnancies who went on to have additional children (1.5 (1.2 to 2.0) after term pre-eclampsia; 2.4 (1.5 to 3.9) after preterm pre-eclampsia). There was little evidence of additional risk after recurrent pre-eclampsia. All cause mortality for women with two or more lifetime births, who had pre-eclampsia in first pregnancy, was not elevated, even with preterm pre-eclampsia in first pregnancy (1.1 (0.87 to 1.14)).
Cardiovascular death in women with pre-eclampsia in their first pregnancy is concentrated mainly in women with no additional births. This association might be due to health problems that discourage or prevent further pregnancies rather than to pre-eclampsia itself. As a screening criterion for cardiovascular disease risk, pre-eclampsia is a strong predictor primarily among women with only one child-particularly with preterm pre-eclampsia.
根据母亲一生中的妊娠次数，特别是仅生育一次后，评估子痫前期与母亲后期心血管死亡的相关性。
前瞻性、基于人群的队列研究。
挪威医学出生登记处。
我们通过与全国死因登记处的链接，对 1967 年至 2002 年间首次单胎出生的 836147 名挪威妇女进行了心血管死亡率的随访。截至 2009 年，约有 23000 名妇女死亡，其中 3891 名死于心血管疾病。通过 Cox 回归分析评估子痫前期与心血管死亡之间的关联，估计风险比。风险比通过 Cox 回归分析进行了调整，调整因素包括母亲教育程度（三个类别）、首次分娩时的母亲年龄以及首次分娩年份。
仅生育一胎的早产子痫前期妇女的心血管死亡率为 9.2%，而生育两胎或以上的妇女为 1.1%。对于足月子痫前期的妇女，这一比例分别为 2.8%和 1.1%。与首次分娩时没有子痫前期的妇女相比，首次妊娠时患有子痫前期的妇女心血管死亡的风险更高（足月子痫前期的调整后的危险比为 1.6（95%置信区间 1.4 至 2.0）；早产子痫前期为 3.7（2.7 至 4.8））。在仅生育一胎的妇女中，心血管死亡风险的增加高于生育两胎或以上的妇女（足月子痫前期为 3.4（2.6 至 4.6）；早产子痫前期为 9.4（6.5 至 13.7））。首次妊娠时患有子痫前期的妇女，如果继续生育，其心血管死亡风险仅略有升高（足月子痫前期为 1.5（1.2 至 2.0）；早产子痫前期为 2.4（1.5 至 3.9））。在反复发生子痫前期的妇女中，几乎没有证据表明存在额外的风险。在有两次或以上生育史且首次妊娠时患有子痫前期的妇女中，全因死亡率并不升高，即使首次妊娠时为早产子痫前期也是如此（1.1（0.87 至 1.14））。
首次妊娠时患有子痫前期的妇女的心血管死亡主要集中在没有再次生育的妇女中。这种关联可能是由于健康问题阻碍或阻止了进一步的妊娠，而不是子痫前期本身。作为心血管疾病风险的筛查标准，子痫前期主要是在仅有一胎的妇女中，尤其是患有早产子痫前期的妇女中，是一个强有力的预测因素。
