Gudnadóttir Thuridur A, Bateman Brian T, Hernádez-Díaz Sonia, Luque-Fernandez Miguel Angel, Valdimarsdottir Unnur, Zoega Helga
Faculty of Medicine, Centre of Public Health Sciences, University of Iceland, Reykjavík, Iceland.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
PLoS One. 2016 Mar 24;11(3):e0152187. doi: 10.1371/journal.pone.0152187. eCollection 2016.
While obesity is an indicated risk factor for hypertensive disorders of pregnancy, smoking during pregnancy has been shown to be inversely associated with the development of preeclampsia and gestational hypertension. The purpose of this study was to investigate the combined effects of high body mass index and smoking on hypertensive disorders during pregnancy. This was a case-control study based on national registers, nested within all pregnancies in Iceland 1989-2004, resulting in birth at the Landspitali University Hospital. Cases (n = 500) were matched 1:2 with women without a hypertensive diagnosis who gave birth in the same year. Body mass index (kg/m2) was based on height and weight at 10-15 weeks of pregnancy. We used logistic regression models to calculate odds ratios and corresponding 95% confidence intervals as measures of association, adjusting for potential confounders and tested for additive and multiplicative interactions of body mass index and smoking. Women's body mass index during early pregnancy was positively associated with each hypertensive outcome. Compared with normal weight women, the multivariable adjusted odds ratio for any hypertensive disorder was 1.8 (95% confidence interval, 1.3-2.3) for overweight women and 3.1 (95% confidence interval, 2.2-4.3) for obese women. The odds ratio for any hypertensive disorder with obesity was 3.9 (95% confidence interval 1.8-8.6) among smokers and 3.0 (95% confidence interval 2.1-4.3) among non-smokers. The effect estimates for hypertensive disorders with high body mass index appeared more pronounced among smokers than non-smokers, although the observed difference was not statistically significant. Our findings may help elucidate the complicated interplay of these lifestyle-related factors with the hypertensive disorders during pregnancy.
虽然肥胖是妊娠期高血压疾病的一个明确风险因素，但孕期吸烟已被证明与子痫前期和妊娠期高血压的发生呈负相关。本研究的目的是调查高体重指数和吸烟对妊娠期高血压疾病的综合影响。这是一项基于国家登记册的病例对照研究，嵌套于1989 - 2004年冰岛所有在Landspitali大学医院出生的妊娠病例中。病例组（n = 500）与同年分娩且无高血压诊断的女性按1:2进行匹配。体重指数（kg/m²）基于妊娠10 - 15周时的身高和体重。我们使用逻辑回归模型计算比值比及相应的95%置信区间作为关联度量，对潜在混杂因素进行调整，并检验体重指数和吸烟的相加和相乘交互作用。孕早期女性的体重指数与每种高血压结局呈正相关。与体重正常的女性相比，超重女性患任何高血压疾病的多变量调整比值比为1.8（95%置信区间，1.3 - 2.3），肥胖女性为3.1（95%置信区间，2.2 - 4.3）。吸烟者中肥胖且患任何高血压疾病的比值比为3.9（95%置信区间1.8 - 8.6），非吸烟者为3.0（95%置信区间2.1 - 4.3）。尽管观察到的差异无统计学意义，但高体重指数对高血压疾病的影响估计在吸烟者中似乎比非吸烟者更明显。我们的研究结果可能有助于阐明这些与生活方式相关的因素与妊娠期高血压疾病之间复杂的相互作用。
