妊娠早期具有母体特征的妊娠期高血压疾病的风险评估：一项单中心队列研究。

Risk assessment of hypertensive disorders in pregnancy with maternal characteristics in early gestation: A single-center cohort study.

作者信息

Muto Haruka, Yamamoto Ryo, Ishii Keisuke, Kakubari Reisa, Takaoka Sachi, Mabuchi Aki, Mitsuda Nobuaki

机构信息

Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.

出版信息

Taiwan J Obstet Gynecol. 2016 Jun;55(3):341-5. doi: 10.1016/j.tjog.2016.04.009.

DOI:10.1016/j.tjog.2016.04.009

PMID:27343312

Abstract

OBJECTIVE

Hypertensive disorders in pregnancy are major causes of maternal mortality and morbidity. Although the combined risk assessments of maternal history, blood pressure, uterine artery Doppler, and maternal serum marker seem to be highly predictive of the development of hypertensive disorders, this method is a little complicated to be performed on many low-risk pregnant women. The aim of this study is to evaluate the use of maternal characteristics, and physical findings early in the second trimester, as predictive factors of hypertensive disorders.

MATERIALS AND METHODS

This is a retrospective cohort study undertaken in a single tertiary care center in Japan. Singleton pregnant women without underlying disease and evaluated before 14 weeks of gestation were included. We conducted multivariate logistic regression analysis and decision tree analysis to elucidate the potential risk factors of hypertensive disorders, including gestational hypertension and preeclampsia.

RESULTS

In total, 1986 women were evaluated, of whom 863 were nulliparous and 1123 were multiparous, and 166 (8.3%) were diagnosed with hypertensive disorders. In multivariate analysis, maternal age ≥ 40 years, prepregnancy BMI ≥ 30 kg/m(2), in vitro fertilization and embryo transfer (IVF-ET), family history of hypertension, and blood pressure ≥ 130/85 mmHg at first visit were independent risk factors for the nulliparous women. Maternal age ≥ 40 years, a history of previous hypertensive disorders, and blood pressure ≥ 130/85 mmHg at first visit were independent risk factors for the multiparous women. According to the decision tree analysis, high-risk populations were as follows: women ≥ 40 years old who conceived thorough IVF-ET and women with prepregnancy BMI ≥ 30 kg/m(2) who conceived spontaneously in nulliparous women; women with a history of hypertensive disorders and women with blood pressure ≥ 130/85 mmHg in the absence of the previous history.

CONCLUSION

The combination of maternal background and physical findings is useful to identify the population with a high risk of hypertensive disorders.

摘要

目的

妊娠期高血压疾病是孕产妇死亡和发病的主要原因。尽管综合评估母亲病史、血压、子宫动脉多普勒检查和母亲血清标志物似乎对预测妊娠期高血压疾病的发生具有较高的准确性，但这种方法对许多低风险孕妇来说实施起来有点复杂。本研究旨在评估孕中期早期的母亲特征和体格检查结果作为妊娠期高血压疾病预测因素的作用。

材料与方法

这是一项在日本一家三级医疗中心进行的回顾性队列研究。纳入无基础疾病且在妊娠14周前接受评估的单胎孕妇。我们进行了多因素逻辑回归分析和决策树分析，以阐明包括妊娠期高血压和子痫前期在内的妊娠期高血压疾病的潜在危险因素。

结果

总共评估了1986名女性，其中863名为初产妇，1123名为经产妇，166名（8.3%）被诊断为妊娠期高血压疾病。在多因素分析中，母亲年龄≥40岁、孕前BMI≥30kg/m²、体外受精和胚胎移植（IVF-ET）、高血压家族史以及首次就诊时血压≥130/85mmHg是初产妇的独立危险因素。母亲年龄≥40岁、既往有妊娠期高血压疾病史以及首次就诊时血压≥130/85mmHg是经产妇的独立危险因素。根据决策树分析，高危人群如下：通过IVF-ET受孕的≥40岁女性以及初产妇中孕前BMI≥30kg/m²且自然受孕的女性；有妊娠期高血压疾病史的女性以及无既往病史但血压≥130/85mmHg的女性。