From the Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute (J.M.C.)
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (G.G.S., M.B.).
Hypertension. 2018 Jul;72(1):159-166. doi: 10.1161/HYPERTENSIONAHA.117.10693. Epub 2018 May 23.
Women who delivered preterm infants have excess cardiovascular disease, but vascular pathways linking these conditions are not understood. We considered that higher blood pressure over 25 years among women with preterm delivery may be associated with coronary artery calcification (CAC). The CARDIA study (Coronary Artery Risk Development in Young Adults) enrolled 1049 black and white women with births between 1985 and 2010 (n=272 ever preterm [<37 weeks]; n=777 all term births [≥37 weeks]). Latent mixture modeling identified blood pressure trajectories across 20 years, and these were related to CAC at years 20 and 25. Three systolic blood pressure (SBP) patterns were identified: low stable (n=563; 53%), moderate (n=416; 40%), and moderate increasing (n=70; 7%). Women with moderate-increasing SBP were more likely to have delivered preterm compared with those in the low-stable group (40% versus 21%; <0.0001), and they were more likely to have CAC (38.5% versus 12.2%). The SBP and CAC association varied by preterm birth ( interaction=0.04). Women with preterm delivery and a moderate-increasing SBP had a 2.17-fold higher hazards of CAC (95% confidence interval, 1.14-4.12) compared with women with term births and a lower SBP pattern, adjusted for cardiovascular disease risk factors and other pregnancy features. There was no excess CAC in women with moderate-increasing SBP and term births (adjusted hazard ratio, 1.02; 95% confidence interval, 0.49-2.14). Associations were stronger in women with hypertensive disorders of pregnancy but also detected in those with normotensive preterm deliveries. Women who deliver preterm infants are more likely to follow a high-risk blood pressure pattern throughout the childbearing years that is associated with CAC at midlife.
早产的女性患心血管疾病的风险较高，但目前尚不清楚这两种疾病之间的血管联系。我们认为，有早产史的女性在 25 年中血压升高可能与冠状动脉钙化（CAC）有关。CARDIA 研究（年轻人冠状动脉风险发展）纳入了 1985 年至 2010 年期间出生的 1049 名黑人和白人女性（n=272 例早产[<37 周]；n=777 例足月分娩[≥37 周]）。潜在混合模型确定了 20 年的血压轨迹，这些轨迹与 20 年和 25 年的 CAC 有关。确定了三种收缩压（SBP）模式：低稳定（n=563；53%）、中等（n=416；40%）和中等升高（n=70；7%）。与低稳定组相比，中等升高 SBP 组的女性更有可能早产（40%比 21%；<0.0001），并且她们更有可能 CAC（38.5%比 12.2%）。SBP 和 CAC 的相关性因早产而有所不同（交互作用=0.04）。与足月分娩且 SBP 模式较低的女性相比，有早产史且 SBP 模式升高的女性 CAC 的危险度增加了 2.17 倍（95%置信区间，1.14-4.12），调整了心血管疾病危险因素和其他妊娠特征。在 SBP 模式升高且足月分娩的女性中，没有 CAC 过度增加（调整后的危险比，1.02；95%置信区间，0.49-2.14）。在有妊娠高血压疾病的女性中，这些关联更强，但在血压正常的早产女性中也有检测到。有早产史的女性在整个生育期更有可能出现高危血压模式，这与中年 CAC 有关。
