Department of Fetal Medicine, King's College Hospital, London, UK.
Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA.
Ultrasound Obstet Gynecol. 2017 Sep;50(3):361-366. doi: 10.1002/uog.17553. Epub 2017 Jul 28.
To examine the effect of chronic hypertension (CH), with and without superimposed pre-eclampsia (PE), on the incidence of a small-for-gestational-age (SGA) neonate and to explore the possible mechanism for such association.
Data for this study were derived from prospective screening for adverse pregnancy outcomes in women with singleton pregnancy attending their first routine hospital visit at 11-13 weeks' gestation, which included recording of maternal characteristics and medical history and measurement of mean arterial pressure (MAP). Birth-weight Z-score, adjusted for gestational age and maternal and pregnancy characteristics, and incidence of SGA were compared between those with and those without CH in the total population and in the subgroups of pregnancies with and without PE. Regression analysis was used to examine the relationship between MAP and birth-weight Z-score and incidence of SGA and PE in those with and those without CH.
The study population constituted 74 226 pregnancies, including 1052 (1.4%) with CH and 73 174 without CH. PE developed in 233 (22.1%) cases of the group with CH and in 1662 (2.3%) of those without CH. In the group that developed PE, there was no significant difference for either median birth-weight Z-score or incidence of SGA between those with CH and those without CH. In the group without PE, the incidence of SGA was twice as high in those with CH than in those without. There was a significant association between log MAP multiples of the median and incidence of SGA and PE, which was more marked in those with CH than in those without.
CH is associated with an increased risk of SGA and PE and this is related to MAP at 11-13 weeks' gestation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
探讨慢性高血压（CH）伴或不伴先兆子痫（PE）对小于胎龄儿（SGA）新生儿发生率的影响，并探讨其可能的关联机制。
本研究数据来源于对 11-13 周龄首次常规医院就诊的单胎妊娠女性进行不良妊娠结局的前瞻性筛查，包括记录产妇特征和病史以及平均动脉压（MAP）的测量。比较了总人群以及有或无 PE 的妊娠人群中，CH 组和无 CH 组之间的出生体重 Z 评分（经胎龄和产妇及妊娠特征校正）和 SGA 发生率。采用回归分析，检查了 MAP 与出生体重 Z 评分和 CH 与无 CH 人群中 SGA 和 PE 发生率之间的关系。
研究人群包括 74226 例妊娠，其中 1052 例（1.4%）有 CH，73174 例无 CH。CH 组中 233 例（22.1%）发生 PE，无 CH 组中 1662 例（2.3%）发生 PE。在发生 PE 的组中，有 CH 者与无 CH 者的中位出生体重 Z 评分或 SGA 发生率无显著差异。在无 PE 的组中，CH 者的 SGA 发生率是无 CH 者的两倍。log MAP 中位数倍数与 SGA 和 PE 的发生率之间存在显著关联，在 CH 者中比在无 CH 者中更为显著。
CH 与 SGA 和 PE 的风险增加相关，这与 11-13 周时的 MAP 有关。版权所有 © 2017 ISUOG。由 John Wiley & Sons Ltd 出版。
