Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia; and the Department of Obstetrics and Gynecology, the University of Alabama at Birmingham, Birmingham, Alabama.
Obstet Gynecol. 2018 May;131(5):827-834. doi: 10.1097/AOG.0000000000002574.
To compare the perinatal outcomes of normotensive women with those of women with a history of chronic hypertension with normal blood pressures before 20 weeks of gestation, stratifying the latter by whether they were receiving antihypertensive medication.
We conducted a retrospective cohort study of all singletons with a history of chronic hypertension from 2000 to 2014. Exclusions were blood pressure greater than 140/90 mm Hg before 20 weeks of gestation, fetal anomalies, major medical problems other than hypertension, and diabetes. For the same time period, a randomly selected group without a diagnosis of chronic hypertension was chosen using the same exclusion criteria. Outcomes were compared among women without chronic hypertension, women with chronic hypertension on no antihypertensive medication but with blood pressures less than 140/90 mm Hg before 20 weeks of gestation, and women with chronic hypertension on antihypertensive medication with blood pressures less than 140/90 mm Hg before 20 weeks of gestation. The primary outcome was a perinatal composite of stillbirth, neonatal death, respiratory support at birth, arterial cord pH less than 7, 5-minute Apgar score 3 or less, and seizures. Secondary outcomes assessed were preterm birth before 37 and 34 weeks of gestation, small for gestational age, and preeclampsia.
Of 830 women with chronic hypertension and blood pressures less than 140/90 mm Hg before 20 weeks of gestation, 212 (26%) were not taking antihypertensive medication and 618 (74%) were. These groups were compared with 476 women without chronic hypertension. Women with hypertension were more likely to be older and have baseline renal disease and diabetes compared with women in the no hypertension group. The perinatal composite was more common in both hypertensive groups: no antihypertensive medication (9.9%) and antihypertensive medication (14.6%) compared with women in the control group (2.9%) (adjusted odds ratio [OR] 2.9, 95% CI 1.21-6.85 no antihypertensive medications compared with no chronic hypertension; adjusted OR 5.0, 95% CI 2.38-10.54 antihypertensive medications vs no chronic hypertension). The risk of early preterm birth, small for gestational age, and preeclampsia was not significantly increased in women with chronic hypertension and no antihypertensive medications compared with women without chronic hypertension.
Despite normal baseline blood pressures without medications before 20 weeks of gestation, women with chronic hypertension are at an increased risk of adverse perinatal outcomes compared with women without.
比较正常血压的慢性高血压女性与妊娠 20 周前血压正常的慢性高血压女性的围产期结局，并对后者是否接受降压药物治疗进行分层。
我们对 2000 年至 2014 年间所有患有慢性高血压的单胎孕妇进行了回顾性队列研究。排除标准为妊娠 20 周前血压大于 140/90mmHg、胎儿畸形、除高血压以外的重大医学问题以及糖尿病。同时，使用相同的排除标准，为同一时期未被诊断为慢性高血压的孕妇随机选择一组。比较无慢性高血压的孕妇、妊娠 20 周前血压小于 140/90mmHg 且未服用降压药的慢性高血压孕妇以及妊娠 20 周前血压小于 140/90mmHg 且服用降压药的慢性高血压孕妇的围产期结局。主要结局是死胎、新生儿死亡、出生时需要呼吸支持、脐动脉血 pH 值小于 7、5 分钟 Apgar 评分小于等于 3 以及抽搐等围产期复合结局。次要结局评估包括妊娠 37 周前和 34 周前早产、小于胎龄儿和子痫前期。
在 830 名妊娠 20 周前血压小于 140/90mmHg 的慢性高血压孕妇中，212 名（26%）未服用降压药，618 名（74%）服用降压药。这些组与 476 名无慢性高血压的孕妇进行了比较。与无高血压组相比，高血压组的孕妇年龄更大，且基线时更易发生肾脏疾病和糖尿病。在两组高血压孕妇中，围产期复合结局更为常见：未服用降压药（9.9%）和服用降压药（14.6%）的孕妇与对照组（2.9%）相比（未服用降压药的调整后比值比[OR]为 2.9，95%可信区间[CI]为 1.21-6.85；服用降压药的调整后 OR 为 5.0，95% CI 为 2.38-10.54）。与无慢性高血压的孕妇相比，妊娠 20 周前未服用降压药的慢性高血压孕妇的早产、小于胎龄儿和子痫前期风险并无显著增加。
尽管妊娠 20 周前未服用药物时的基础血压正常，但与无慢性高血压的孕妇相比，患有慢性高血压的孕妇发生不良围产期结局的风险增加。
