Tolcher Mary Catherine, Chu Derrick M, Hollier Lisa M, Mastrobattista Joan M, Racusin Diana A, Ramin Susan M, Sangi-Haghpeykar Haleh, Aagaard Kjersti M
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas-Houston, Houston, TX.
Am J Obstet Gynecol. 2017 Sep;217(3):365.e1-365.e8. doi: 10.1016/j.ajog.2017.04.035. Epub 2017 Apr 25.
The US Preventive Services Task Force recommends low-dose aspirin for the prevention of preeclampsia among women at high risk for primary occurrence or recurrence of disease. Recommendations for the use of aspirin for preeclampsia prevention were issued by the US Preventive Services Task Force in September 2014.
The objective of the study was to evaluate the incidence of recurrent preeclampsia in our cohort before and after the US Preventive Services Task Force recommendation for aspirin for preeclampsia prevention.
This was a retrospective cohort study designed to evaluate the rates of recurrent preeclampsia among women with a history of preeclampsia. We utilized a 2-hospital, single academic institution database from August 2011 through June 2016. We excluded multiple gestations and included only the first delivery for women with multiple deliveries during the study period. The cohort of women with a history of preeclampsia were divided into 2 groups, before and after the release of the US Preventive Services Task Force 2014 recommendations. Potential confounders were accounted for in multivariate analyses, and relative risk and adjusted relative risk were calculated.
A total of 17,256 deliveries occurred during the study period. A total of 417 women had a documented history of prior preeclampsia: 284 women before and 133 women after the US Preventive Services Task Force recommendation. Comparing the before and after groups, the proportion of Hispanic women in the after group was lower and the method of payment differed between the groups (P <.0001). The prevalence of type 1 diabetes was increased in the after period, but overall rates of pregestational diabetes were similar (6.3% before vs 5.3% after [P > .05]). Risk factors for recurrent preeclampsia included maternal age >35 years (relative risk, 1.83; 95% confidence interval, 1.34-2.48), Medicaid insurance (relative risk, 2.08; 95% confidence interval, 1.15-3.78), type 2 diabetes (relative risk, 2.13; 95% confidence interval, 1.37-3.33), and chronic hypertension (relative risk, 1.96; 95% confidence interval, 1.44-2.66). The risk of recurrent preeclampsia was decreased by 30% in the after group (adjusted relative risk, 0.70; 95% confidence interval, 0.52-0.95).
Rates of recurrent preeclampsia among women with a history of preeclampsia decreased by 30% after release of the US Preventive Services Task Force recommendation for aspirin for preeclampsia prevention. Future prospective studies should include direct measures of aspirin compliance, gestational age at initiation, and explore the influence of race and ethnicity on the efficacy of this primary prevention.
美国预防服务工作组建议，对于初发或复发子痫前期风险较高的女性，使用低剂量阿司匹林预防子痫前期。美国预防服务工作组于2014年9月发布了关于使用阿司匹林预防子痫前期的建议。
本研究的目的是评估在美国预防服务工作组发布阿司匹林预防子痫前期建议前后，我们队列中复发性子痫前期的发生率。
这是一项回顾性队列研究，旨在评估有子痫前期病史女性的复发性子痫前期发生率。我们使用了2011年8月至2016年6月期间来自两家医院的单一学术机构数据库。我们排除了多胎妊娠，仅纳入研究期间多次分娩女性的首次分娩。有子痫前期病史的女性队列在2014年美国预防服务工作组发布建议前后分为两组。在多变量分析中考虑了潜在混杂因素，并计算了相对风险和调整后的相对风险。
研究期间共发生17256例分娩。共有417名女性有子痫前期病史记录：美国预防服务工作组建议发布前284名女性，建议发布后133名女性。比较前后两组，后一组中西班牙裔女性的比例较低，两组之间的支付方式不同（P<.0001）。1型糖尿病的患病率在建议发布后有所增加，但孕前糖尿病的总体发生率相似（之前为6.3%，之后为5.3%[P>.05]）。复发性子痫前期的风险因素包括产妇年龄>35岁（相对风险，1.83；95%置信区间，1.34 - 2.48）、医疗补助保险（相对风险，2.08；95%置信区间，1.15 - 3.78）、2型糖尿病（相对风险，2.13；95%置信区间，1.37 - 3.33）和慢性高血压（相对风险，1.96；95%置信区间，1.44 - 2.66）。后一组中复发性子痫前期的风险降低了30%（调整后的相对风险，0.70；95%置信区间，0.52 - 0.95）。
在美国预防服务工作组发布阿司匹林预防子痫前期建议后，有子痫前期病史女性的复发性子痫前期发生率降低了30%。未来的前瞻性研究应包括阿司匹林依从性的直接测量、开始用药时的孕周，并探讨种族和民族对这种一级预防疗效的影响。
