Department of Paediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
National Office for Maternal and Child Health Surveillance Sichuan University, Chengdu, China.
Bull World Health Organ. 2018 Aug 1;96(8):531-539. doi: 10.2471/BLT.18.208447. Epub 2018 Jun 12.
To assess the association between hypertensive disorders in pregnancy and the stillbirth rate.
We obtained all data from China's National Maternal Near Miss Surveillance System for 2012 to 2016. Associations between hypertensive disorders in pregnancy and stillbirths, stratified by fetus number and gestational age, were assessed using Poisson regression analysis with a robust variance estimator.
For the period, 6 970 032 births, including 66 494 stillbirths, were reported to the surveillance system. The weighted stillbirth rate in women with a hypertensive disorder in pregnancy was 21.9 per 1000 births. The risk was higher in those who had received few antenatal care visits or who were poorly educated. For singleton pregnancies, the adjusted risk ratio (aRR) for a stillbirth among women with hypertensive disorders in pregnancy compared with normotensive women was 3.1 (95% confidence interval, CI: 2.85-3.37). The aRR for hypertensive disorder subtypes was: 6.66 (95% CI: 5.57-7.96) for superimposed preeclampsia; 4.15 (95% CI: 3.81-4.52) for preeclampsia or eclampsia; 2.32 (95% CI: 1.87-2.88) for chronic hypertension; and 1.21 (95% CI: 1.08-1.36) for gestational hypertension. For multiple pregnancies, the association between stillbirths and hypertensive disorders in pregnancy was not significant, except for superimposed preeclampsia (aRR: 1.95; 95% CI: 1.28-2.97).
To minimize the incidence of stillbirths, more attention should be paid to chronic hypertension and superimposed preeclampsia in singleton pregnancies and to superimposed preeclampsia in multiple pregnancies. Better quality antenatal care and improved guidelines are needed in China.
评估妊娠高血压疾病与死胎率之间的关联。
我们从中国 2012 年至 2016 年的全国孕产妇严重疾病监测系统中获取了所有数据。使用泊松回归分析和稳健方差估计，按胎儿数量和胎龄分层，评估妊娠高血压疾病与死胎之间的关联。
在此期间，向监测系统报告了 697 万零 320 例分娩，其中包括 66494 例死胎。患有妊娠高血压疾病的女性的加权死胎率为每 1000 例分娩 21.9 例。接受产前检查次数较少或受教育程度较低的女性风险更高。对于单胎妊娠，与正常血压孕妇相比，患有妊娠高血压疾病的女性死胎的调整风险比（aRR）为 3.1（95%置信区间，CI：2.85-3.37）。妊娠高血压疾病各亚型的 aRR 分别为：重叠性子痫前期为 6.66（95%CI：5.57-7.96）；子痫前期或子痫为 4.15（95%CI：3.81-4.52）；慢性高血压为 2.32（95%CI：1.87-2.88）；妊娠期高血压为 1.21（95%CI：1.08-1.36）。对于多胎妊娠，除了重叠性子痫前期（aRR：1.95；95%CI：1.28-2.97）外，死胎与妊娠高血压疾病之间的关联不显著。
为了最大限度地降低死胎发生率，应更加关注单胎妊娠中的慢性高血压和重叠性子痫前期以及多胎妊娠中的重叠性子痫前期。中国需要更好的产前保健质量和改进的指南。
