Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Mississauga Academy of Medicine, University of Toronto Mississauga, Mississauga, Canada.
Am J Epidemiol. 2018 Oct 1;187(10):2073-2079. doi: 10.1093/aje/kwy138.
While there is consistent evidence that episodes of physical exertion are associated with an immediately higher risk of acute ischemic vascular events, the risk of placental abruption immediately following episodes of physical exertion has not been studied. In a multicenter case-crossover study, we interviewed 663 women with placental abruption at 7 Peruvian hospitals between January 2013 and August 2015. We asked women about physical exertion in the hour before symptom onset and compared this with their frequency of physical exertion over the prior week. Compared with times with light or no exertion, the risk of placental abruption was 7.8 (95% confidence interval (CI): 5.5, 11.0) times greater in the hour following moderate or heavy physical exertion. The instantaneous incidence rate ratio of placental abruption within an hour of moderate or heavy physical exertion was lower for women who habitually engaged in moderate or heavy physical activity more than 3 times per week in the year before pregnancy (rate ratio (RR) = 3.0, 95% CI: 1.6, 5.9) compared with more sedentary women (RR = 17.3, 95% CI: 11.3, 26.7; P for homogeneity < 0.001), and the rate ratio was higher among women with preeclampsia/eclampsia (RR = 13.6, 95% CI: 7.0, 26.2) than among women without (RR = 6.7, 95% CI: 4.4, 10.0; P for homogeneity = 0.07).
虽然有一致的证据表明，身体活动会立即增加急性缺血性血管事件的风险，但身体活动后立即发生胎盘早剥的风险尚未得到研究。在一项多中心病例交叉研究中，我们在 2013 年 1 月至 2015 年 8 月期间对秘鲁 7 家医院的 663 名胎盘早剥女性进行了访谈。我们询问了女性在症状发作前 1 小时内的体力活动情况，并将其与前一周的体力活动频率进行了比较。与轻度或无体力活动相比，中度或重度体力活动后 1 小时内发生胎盘早剥的风险增加 7.8 倍（95%置信区间：5.5，11.0）。在妊娠前一年每周至少进行 3 次中度或重度体力活动的女性，其胎盘早剥在 1 小时内的瞬时发病率比久坐不动的女性低（率比（RR）=3.0，95%置信区间：1.6，5.9）（RR=17.3，95%置信区间：11.3，26.7；P 异质性<0.001），且患有子痫前期/子痫的女性（RR=13.6，95%置信区间：7.0，26.2）的 RR 高于无子痫前期/子痫的女性（RR=6.7，95%置信区间：4.4，10.0；P 异质性=0.07）。
