Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA.
Department of Obstetrics and Gynecology/Maternal-Fetal Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
Heart. 2018 Jul;104(14):1187-1194. doi: 10.1136/heartjnl-2017-312299. Epub 2018 Jan 11.
Women with pregnancies complicated by hypertensive disorders of pregnancy (HDP) have increased long-term cardiovascular (CV) risk. We sought to determine if they demonstrate increased short-term CV risk.
Using administrative records, all hospital-based deliveries in Florida from 2004 to 2010 and subsequent readmission to any Florida hospital within 3 years of index delivery were identified. Deliveries and clinical diagnoses were determined using International Classification of Diseases, Ninth Revision, Clinical Modification codes. HDP included pregnancies complicated by gestational hypertension, pre-eclampsia or eclampsia. Outcomes were CV readmission (acute myocardial infarction, stroke or heart failure), non-CV readmission and any readmission within 3 years of delivery excluding subsequent deliveries. Associations were determined using multivariate logistic regression.
Among 1 452 926 records from delivering mothers of singleton infants (mean age 27.2±6.2 years; 52% white, 23% African American (AA), 18% Hispanic), there were 4054 CV and 259 252 non-CV readmissions. Women with HDP had higher CV readmission rates (6.4 vs 2.5/1000 deliveries; P<0.001). AA women had higher rates of CV readmission than whites or Hispanics (6.8 vs 1.7 vs 1.0/1000 deliveries, respectively; P<0.001). Women with HDP had higher multivariate risk of CV readmission (OR 2.41; 95% CI 2.08 to 2.80) and any readmission (OR 1.13; 95% CI 1.10 to 1.15). Compared with whites, AA women had higher risk for CV readmission (OR 3.60; 95% CI 3.32 to 3.90) after adjustment for HDP.
Women with HDP had twice the risk of CV readmission within 3 years of delivery, with higher rates among AA women. More work is needed to explore preventive strategies for HDP-associated events.
患有妊娠合并高血压疾病（HDP）的孕妇具有增加的长期心血管（CV）风险。我们试图确定她们是否具有增加的短期 CV 风险。
使用行政记录，确定了 2004 年至 2010 年佛罗里达州所有基于医院的分娩情况，以及分娩后 3 年内任何佛罗里达州医院的后续再入院情况。分娩和临床诊断使用国际疾病分类，第九版，临床修正代码确定。HDP 包括妊娠合并妊娠期高血压、先兆子痫或子痫。结局为 CV 再入院（急性心肌梗死、中风或心力衰竭）、非 CV 再入院和分娩后 3 年内的任何再入院（不包括后续分娩）。使用多变量逻辑回归确定关联。
在 1 452 926 份来自单胎分娩母亲的记录中（平均年龄 27.2±6.2 岁；52%为白人，23%为非裔美国人（AA），18%为西班牙裔），有 4054 例 CV 再入院和 259 252 例非 CV 再入院。患有 HDP 的女性 CV 再入院率更高（6.4 比 2.5/1000 分娩；P<0.001）。AA 女性的 CV 再入院率高于白人或西班牙裔（分别为 6.8 比 1.7 比 1.0/1000 分娩；P<0.001）。患有 HDP 的女性具有更高的 CV 再入院风险（OR 2.41；95%置信区间 2.08 至 2.80）和任何再入院风险（OR 1.13；95%置信区间 1.10 至 1.15）。在调整 HDP 后，与白人相比，AA 女性的 CV 再入院风险更高（OR 3.60；95%置信区间 3.32 至 3.90）。
患有 HDP 的女性在分娩后 3 年内 CV 再入院的风险增加了一倍，而 AA 女性的风险更高。需要进一步研究预防 HDP 相关事件的策略。
