Countouris Malamo E, Schwarz Eleanor B, Rossiter Brianna C, Althouse Andrew D, Berlacher Kathryn L, Jeyabalan Arun, Catov Janet M
Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA.
University of California, Davis, Sacramento, CA.
Am J Obstet Gynecol. 2016 Aug;215(2):241.e1-8. doi: 10.1016/j.ajog.2016.02.046. Epub 2016 Mar 2.
Women with a history of hypertensive disorders of pregnancy are at an increased risk of hypertension and cardiovascular disease in later life. Lactation has been associated with a reduced risk of maternal hypertension, both in the postpartum period and later life. However, little is known about whether lactation is also cardioprotective in women with hypertensive disorders of pregnancy such as preeclampsia or gestational hypertension.
This study aimed to characterize the relationship between lactation and postpartum blood pressure among women with preeclampsia and gestational hypertension.
Data were obtained from women who participated in the Prenatal Exposures and Preeclampsia Prevention study (n = 379; 66% African American; 85% overweight or obese). Women enrolled during pregnancy and attended a postpartum visit (on average, 9.1 months after delivery) during which data on lactation duration and blood pressure were collected. The significance of the associations between postpartum blood pressure and lactation among women who remained normotensive during pregnancy, developed gestational hypertension, or developed preeclampsia were assessed with an analysis of variance. Linear regression models were used to adjust for maternal age, race, education, prepregnancy weight, and time since delivery.
Gestational hypertension affected 42 subjects (11%) and preeclampsia affected 33 (9%). Lactation was reported by 217 (57%) with 78 (21%) reporting ≥ 6 months of lactation. Women who lactated were somewhat older, more educated, and had higher socioeconomic status. Among women who had gestational hypertension, lactation was associated with lower systolic blood pressure (P = .02) and diastolic blood pressure (P = .02). This association persisted after adjustment for age, race, education, prepregnancy weight, and time since delivery. However, for women who had preeclampsia and women who remained normotensive during pregnancy, lactation was not associated with postpartum blood pressure in either bivariate or multivariate analyses.
This study found that lactation is associated with lower postpartum blood pressure among overweight women who develop gestational hypertension but not among women who develop preeclampsia. Future studies are needed to explore the association of lactation and blood pressure in later life for women with hypertensive disorders of pregnancy.
有妊娠高血压疾病史的女性在晚年患高血压和心血管疾病的风险增加。哺乳与产后及晚年患母体高血压风险降低有关。然而，对于哺乳在患有先兆子痫或妊娠高血压等妊娠高血压疾病的女性中是否也具有心脏保护作用，人们知之甚少。
本研究旨在描述先兆子痫和妊娠高血压女性中哺乳与产后血压之间的关系。
数据来自参与产前暴露与先兆子痫预防研究的女性（n = 379；66%为非裔美国人；85%超重或肥胖）。女性在孕期入组并参加产后访视（平均在分娩后9.1个月），期间收集哺乳时长和血压数据。采用方差分析评估孕期血压正常、患妊娠高血压或患先兆子痫的女性产后血压与哺乳之间关联的显著性。使用线性回归模型对产妇年龄、种族、教育程度、孕前体重和分娩后时间进行校正。
42名受试者（11%）患妊娠高血压，33名（9%）患先兆子痫。217名（57%）报告有哺乳，其中78名（21%）报告哺乳≥6个月。哺乳的女性年龄稍大、受教育程度更高且社会经济地位更高。在患妊娠高血压的女性中，哺乳与较低的收缩压（P = 0.02）和舒张压（P = 0.02）相关。在对年龄、种族、教育程度、孕前体重和分娩后时间进行校正后，这种关联仍然存在。然而，对于患先兆子痫的女性以及孕期血压一直正常的女性，在双变量和多变量分析中，哺乳与产后血压均无关联。
本研究发现，哺乳与患妊娠高血压的超重女性产后血压较低有关，但与患先兆子痫的女性无关。需要进一步研究探讨有妊娠高血压疾病的女性哺乳与晚年血压之间的关联。
