Ananth Cande V, Hansen Anne Vinkel, Williams Michelle A, Nybo Andersen Anne-Marie
Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY.
Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY.
Paediatr Perinat Epidemiol. 2017 May;31(3):209-218. doi: 10.1111/ppe.12347. Epub 2017 Feb 21.
Cardiovascular (CVD) complications stemming from vascular dysfunction have been widely explored in the setting of preeclampsia. However, the impact of abruption, a strong indicator of microvascular disturbance, on the risk of CVD mortality and morbidity remains poorly characterised.
We designed a cohort analysis of 828 289 women who delivered singletons in Denmark between 1978 and 2010. We linked the National Patient Registry and the Registry of Causes of Death to the Danish Birth Registry to ascertain CVD events. We estimated CVD risks in relation to abruption from Cox proportional hazards regression following adjustments for confounders.
With 13 231 562 person-years of follow-up of women with at least one delivery, 11 829 pregnancies were complicated by abruption. The median (interquartile range) follow-up in the non-abruption and abruption groups was 16 (8, 24) and 18 (10, 25) years, respectively. CVD mortality rates in women with and without abruption were 0.9 and 0.3 per 10 000 person-years, respectively (adjusted hazard ratio (HR) 2.7, 95% confidence interval (CI) 1.5, 5.0). The corresponding CVD morbidity complication rates were 16.7 and 10.0 per 10 000 person-years, respectively (HR 1.5, 95% CI 1.4, 1.8). The increased risks were evident for ischaemic heart disease, acute myocardial infarction, hypertensive heart disease, non-rheumatic valvular disease, and congestive heart failure.
This study shows increased hazards of CVD morbidity and mortality in relation to abruption. A better understanding of the pathogenesis of distorted placental microvasculature is needed as this appears to be a harbinger of CVD later in life.
子痫前期情况下，血管功能障碍引发的心血管（CVD）并发症已得到广泛研究。然而，胎盘早剥作为微血管紊乱的一个重要指标，其对CVD死亡率和发病率风险的影响仍未得到充分描述。
我们对1978年至2010年间在丹麦分娩单胎的828289名女性进行了队列分析。我们将国家患者登记处和死亡原因登记处与丹麦出生登记处相链接，以确定CVD事件。在对混杂因素进行调整后，我们通过Cox比例风险回归估计了与胎盘早剥相关的CVD风险。
在对至少分娩一次的女性进行了13231562人年的随访中，11829例妊娠并发胎盘早剥。无胎盘早剥组和胎盘早剥组的中位（四分位间距）随访时间分别为16（8，24）年和18（10，25）年。有胎盘早剥和无胎盘早剥女性的CVD死亡率分别为每10000人年0.9例和0.3例（调整后风险比（HR）2.7，95%置信区间（CI）1.5，5.0）。相应的CVD发病并发症发生率分别为每10000人年16.7例和10.0例（HR 1.5，95%CI 1.4，1.8）。缺血性心脏病、急性心肌梗死、高血压性心脏病、非风湿性瓣膜病和充血性心力衰竭的风险增加明显。
本研究表明，与胎盘早剥相关的CVD发病率和死亡率风险增加。需要更好地了解胎盘微血管扭曲的发病机制，因为这似乎是日后发生CVD的先兆。
