Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital, London SE1 7EH, United Kingdom.
BMJ. 2014 Apr 15;348:g2301. doi: 10.1136/bmj.g2301.
To provide an accurate assessment of complications of pregnancy in women with chronic hypertension, including comparison with population pregnancy data (US) to inform pre-pregnancy and antenatal management strategies.
Systematic review and meta-analysis.
Embase, Medline, and Web of Science were searched without language restrictions, from first publication until June 2013; the bibliographies of relevant articles and reviews were hand searched for additional reports.
Studies involving pregnant women with chronic hypertension, including retrospective and prospective cohorts, population studies, and appropriate arms of randomised controlled trials, were included.
Pooled incidence for each pregnancy outcome was reported and, for US studies, compared with US general population incidence from the National Vital Statistics Report (2006).
55 eligible studies were identified, encompassing 795,221 pregnancies. Women with chronic hypertension had high pooled incidences of superimposed pre-eclampsia (25.9%, 95% confidence interval 21.0% to 31.5 %), caesarean section (41.4%, 35.5% to 47.7%), preterm delivery <37 weeks' gestation (28.1% (22.6 to 34.4%), birth weight <2500 g (16.9%, 13.1% to 21.5%), neonatal unit admission (20.5%, 15.7% to 26.4%), and perinatal death (4.0%, 2.9% to 5.4%). However, considerable heterogeneity existed in the reported incidence of all outcomes (τ(2)=0.286-0.766), with a substantial range of incidences in individual studies around these averages; additional meta-regression did not identify any influential demographic factors. The incidences (the meta-analysis average from US studies) of adverse outcomes in women with chronic hypertension were compared with women from the US national population dataset and showed higher risks in those with chronic hypertension: relative risks were 7.7 (95% confidence interval 5.7 to 10.1) for superimposed pre-eclampsia compared with pre-eclampsia, 1.3 (1.1 to 1.5) for caesarean section, 2.7 (1.9 to 3.6) for preterm delivery <37 weeks' gestation, 2.7 (1.9 to 3.8) for birth weight <2500 g, 3.2 (2.2 to 4.4) for neonatal unit admission, and 4.2 (2.7 to 6.5) for perinatal death.
This systematic review, reporting meta-analysed data from studies of pregnant women with chronic hypertension, shows that adverse outcomes of pregnancy are common and emphasises a need for heightened antenatal surveillance. A consistent strategy to study women with chronic hypertension is needed, as previous study designs have been diverse. These findings should inform counselling and contribute to optimisation of maternal health, drug treatment, and pre-pregnancy management in women affected by chronic hypertension.
准确评估慢性高血压孕妇的妊娠并发症，包括与美国人群妊娠数据进行比较，为孕前和产前管理策略提供信息。
系统评价和荟萃分析。
无语言限制地检索 Embase、Medline 和 Web of Science，检索时间从首次发表至 2013 年 6 月；同时还对相关文章和综述的参考文献进行了手工检索，以获取更多报告。
纳入了患有慢性高血压的孕妇的研究，包括回顾性和前瞻性队列研究、人群研究和适当的随机对照试验分组。
报告了每个妊娠结局的汇总发生率，并对美国研究与美国国家生命统计报告（2006 年）中的美国一般人群发生率进行了比较。
确定了 55 项符合条件的研究，涵盖了 795221 例妊娠。患有慢性高血压的孕妇发生重度子痫前期（25.9%，95%置信区间 21.0%至 31.5%）、剖宫产（41.4%，35.5%至 47.7%）、早产（<37 孕周）（28.1%（22.6%至 34.4%）、出生体重<2500 g（16.9%，13.1%至 21.5%）、新生儿重症监护病房入住（20.5%，15.7%至 26.4%）和围产儿死亡（4.0%，2.9%至 5.4%）的汇总发生率均较高。然而，所有结局的报告发生率均存在较大的异质性（τ(2)=0.286-0.766），个别研究的发生率在平均值周围存在较大差异；进一步的多元回归分析未发现任何有影响的人口统计学因素。与来自美国国家人群数据集的女性相比，患有慢性高血压的女性的不良妊娠结局发生率（荟萃分析来自美国研究的平均值）更高：重度子痫前期与子痫前期相比的相对风险为 7.7（95%置信区间 5.7 至 10.1），剖宫产的相对风险为 1.3（1.1 至 1.5），<37 孕周早产的相对风险为 2.7（1.9 至 3.6），出生体重<2500 g 的相对风险为 2.7（1.9 至 3.8），新生儿重症监护病房入住的相对风险为 3.2（2.2 至 4.4），围产儿死亡的相对风险为 4.2（2.7 至 6.5）。
本系统评价报告了来自患有慢性高血压的孕妇研究的荟萃分析数据，表明妊娠不良结局较为常见，强调需要加强产前监测。需要采用一致的策略来研究患有慢性高血压的女性，因为先前的研究设计存在差异。这些发现应有助于咨询，并有助于优化患有慢性高血压女性的母婴健康、药物治疗和孕前管理。
