Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, BC, Canada.
Am J Obstet Gynecol. 2013 Dec;209(6):544.e1-544.e12. doi: 10.1016/j.ajog.2013.08.019. Epub 2013 Aug 22.
The population-based incidence of early-onset (<34 weeks) and late-onset preeclampsia (≥34 weeks) has not been adequately studied. We examined the gestational age-specific incidence of preeclampsia onset and identified the associated risk factors and birth outcomes.
All singleton deliveries in Washington State, 2003-2008 (n = 456,668), were included, and preeclampsia onset was determined from hospital records linked to birth certificates. Cox and logistic regression models were used to obtain adjusted hazard ratios and odds ratios (AORs) for risk factors and birth outcomes, respectively.
The overall preeclampsia rate was 3.1% and the incidence increased sharply with gestation; early- and late-onset preeclampsia rates were 0.38% and 2.72%, respectively. Among women with early-onset preeclampsia, 12% delivered at a gestation of 34 weeks or longer. Risk/protective factors common to both diseases included older maternal age, Hispanic and Native-American race, smoking, unmarried status, and male fetus. African-American race, chronic hypertension, and congenital anomalies were more strongly associated with early-onset preeclampsia, whereas younger maternal age, nulliparity, and diabetes mellitus were more strongly associated with late-onset disease. Early- but not late-onset preeclampsia conferred a high risk of fetal death (AOR, 5.8; 95% confidence interval [CI], 4.0-8.3 vs AOR, 1.3; 95% CI, 0.8-2.0, respectively). The AOR for perinatal death/severe neonatal morbidity was 16.4 (95% CI, 14.5-18.6) in early-onset and 2.0 (95% CI, 1.8-2.3) in late-onset preeclampsia.
Early- and late-onset preeclampsia shares some etiological features, differ with regard to several risk factors, and lead to different outcomes. The 2 preeclampsia types should be treated as distinct entities from an etiological and prognostic standpoint.
早发型（<34 周）和晚发型子痫前期（≥34 周）的基于人群的发病率尚未得到充分研究。我们检查了子痫前期发病的特定胎龄发病率，并确定了相关的危险因素和分娩结局。
纳入 2003 年至 2008 年华盛顿州所有单胎分娩（n=456668），并从与出生证明相关联的医院记录中确定子痫前期发病情况。使用 Cox 和逻辑回归模型分别获得危险因素和分娩结局的调整后的危险比和比值比（AOR）。
总体子痫前期发生率为 3.1%，且发病率随胎龄急剧增加；早发型和晚发型子痫前期的发生率分别为 0.38%和 2.72%。在早发型子痫前期患者中，12%的患者在 34 周或以上的胎龄分娩。两种疾病共有的风险/保护因素包括母亲年龄较大、西班牙裔和美洲原住民种族、吸烟、未婚状态和男性胎儿。与早发型子痫前期更密切相关的是非洲裔美国人种族、慢性高血压和先天性异常，而与晚发型疾病更密切相关的是母亲年龄较小、初产妇和糖尿病。早发型子痫前期而非晚发型子痫前期导致胎儿死亡的风险很高（AOR，5.8；95%置信区间[CI]，4.0-8.3 与 AOR，1.3；95% CI，0.8-2.0）。早发型子痫前期的围产期死亡/严重新生儿发病率的 AOR 为 16.4（95%CI，14.5-18.6），晚发型子痫前期为 2.0（95%CI，1.8-2.3）。
早发型和晚发型子痫前期具有一些病因特征，在某些危险因素方面存在差异，并导致不同的结局。从病因学和预后的角度来看，这两种子痫前期类型应被视为不同的实体。
