Mahande Michael J, Daltveit Anne K, Mmbaga Blandina T, Masenga Gileard, Obure Joseph, Manongi Rachel, Lie Rolv T
Kilimanjaro Christian Medical University College, Moshi, Tanzania ; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ; Centre for International Health, University of Bergen, Bergen, Norway.
PLoS One. 2013 Nov 1;8(11):e79116. doi: 10.1371/journal.pone.0079116. eCollection 2013.
Preeclampsia occurs in about 4 per cent of pregnancies worldwide, and may have particularly serious consequences for women in Africa. Studies in western countries have shown that women with preeclampsia in one pregnancy have a substantially increased risk of preeclampsia in subsequent pregnancies. We estimate the recurrence risks of preeclampsia in data from Northern Tanzania.
A prospective cohort study was designed using 19,811 women who delivered singleton infants at a hospital in Northern Tanzania between 2000 and 2008. A total of 3,909 women were recorded with subsequent deliveries in the hospital with follow up through 2010. Adjusted recurrence risks of preeclampsia were computed using regression models.
The absolute recurrence risk of preeclampsia was 25%, which was 9.2-fold (95% CI: 6.4 - 13.2) compared with the risk for women without prior preeclampsia. When there were signs that the preeclampsia in a previous pregnancy had been serious either because the baby was delivered preterm or had died in the perinatal period, the recurrence risk of preeclampsia was even higher. Women who had preeclampsia had increased risk of a series of adverse pregnancy outcomes in future pregnancies. These include perinatal death (RR= 4.3), a baby with low birth weight (RR= 3.5), or a preterm birth (RR= 2.5). These risks were only partly explained by recurrence of preeclampsia.
Preeclampsia in one pregnancy is a strong predictor for preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies in Tanzania. Women with previous preeclampsia may benefit from close follow-up during their pregnancies.
子痫前期在全球约4%的妊娠中出现，对非洲女性可能有特别严重的后果。西方国家的研究表明，一次妊娠患子痫前期的女性在随后妊娠中患子痫前期的风险大幅增加。我们在坦桑尼亚北部的数据中估计子痫前期的复发风险。
采用前瞻性队列研究，研究对象为2000年至2008年在坦桑尼亚北部一家医院分娩单胎婴儿的19811名女性。共有3909名女性记录了随后在该医院的分娩情况，并随访至2010年。使用回归模型计算子痫前期的调整复发风险。
子痫前期的绝对复发风险为25%，与无子痫前期病史的女性相比，风险高9.2倍（95%可信区间：6.4 - 13.2）。如果先前妊娠中有子痫前期病情严重的迹象，如婴儿早产或围产期死亡，子痫前期的复发风险更高。患子痫前期的女性在未来妊娠中出现一系列不良妊娠结局的风险增加。这些包括围产期死亡（相对危险度= 4.3）、低出生体重儿（相对危险度= 3.5）或早产（相对危险度= 2.5）。这些风险仅部分由子痫前期的复发所解释。
一次妊娠患子痫前期是坦桑尼亚随后妊娠中患子痫前期及其他不良妊娠结局的有力预测指标。有子痫前期病史的女性在孕期密切随访可能有益。
