Magee-Womens Research Institute, and the Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2018 Oct;132(4):843-849. doi: 10.1097/AOG.0000000000002870.
To evaluate maternal and neonatal outcomes in healthy, nulliparous women classified with stage 1 hypertension under the revised American College of Cardiology and American Heart Association Guidelines and to evaluate the effects of low-dose aspirin on maternal and neonatal outcomes in this population.
We conducted a secondary analysis of data from a multicenter randomized, double-blind, placebo-controlled trial of low-dose aspirin for prevention of preeclampsia in nulliparous, low-risk women recruited between 13 and 25 weeks of gestation. Of the 3,134 nulliparous women enrolled in the original study, 2,947 women with singleton pregnancies and without missing data were included in this analysis. Blood pressure was measured at enrollment between 13 and 25 weeks of gestation and outcomes were adjudicated from the medical record.
One hundred sixty-four participants were identified with lower range stage 1 hypertension (5.6%), systolic blood pressure 130-135 mm Hg, diastolic blood pressure 80-85 mm Hg, or both by the new American College of Cardiology-American Heart Association guidelines. Within the placebo group (n=1,482), women with stage 1 hypertension had a significantly increased incidence of preeclampsia compared with normotensive women, 15.3% (15/98) vs 5.4% (75/1,384) (relative risk 2.66, 95% CI 1.56-4.54, P<.001). Moreover, women with stage 1 hypertension had an increased incidence of gestational diabetes mellitus (6.1% vs 2.5%, P=.03) and more indicated preterm deliveries (4.2% vs 1.1%, P=.01). Comparing women with stage 1 hypertension and normotensive women receiving low-dose aspirin during pregnancy (n=1,465), no differences in rates of preeclampsia (7.6% vs 4.4%, respectively, P=.2), gestational diabetes mellitus, or indicated preterm deliveries were observed. Rates of placenta abruption, small for gestational age, and spontaneous preterm birth did not differ significantly between groups.
Application of the new American College of Cardiology-American Heart Association guidelines in a pregnant population identifies a cohort of women who are at increased risk for preeclampsia, gestational diabetes mellitus, and preterm birth.
评估根据修订后的美国心脏病学会/美国心脏协会指南分类为 1 期高血压的健康初产妇的母婴结局，并评估小剂量阿司匹林对该人群母婴结局的影响。
我们对一项多中心、随机、双盲、安慰剂对照试验的二次分析，该试验旨在评估小剂量阿司匹林用于预防低危初产妇子痫前期。该原始研究共纳入 3134 例初产妇，本分析纳入了 2947 例单胎妊娠且无缺失数据的患者。血压在妊娠 13 至 25 周时进行测量，结局从病历中判断。
根据新的美国心脏病学会/美国心脏协会指南，164 例（5.6%）参与者被诊断为低范围 1 期高血压（收缩压 130-135mmHg，舒张压 80-85mmHg，或两者兼有）。在安慰剂组（n=1482）中，与血压正常的女性相比，1 期高血压女性子痫前期的发生率显著增加，分别为 15.3%（15/98）和 5.4%（75/1384）（相对风险 2.66，95%CI 1.56-4.54，P<.001）。此外，1 期高血压女性发生妊娠期糖尿病的发生率增加（6.1%比 2.5%，P=.03），需要提前分娩的比例增加（4.2%比 1.1%，P=.01）。比较妊娠期间接受小剂量阿司匹林治疗的 1 期高血压和血压正常女性（n=1465），两组子痫前期发生率（分别为 7.6%和 4.4%，P=.2）、妊娠期糖尿病或需要提前分娩的发生率无差异。胎盘早剥、胎儿生长受限和自发性早产的发生率在两组间无显著差异。
在孕妇人群中应用新的美国心脏病学会/美国心脏协会指南确定了一组子痫前期、妊娠期糖尿病和早产风险增加的女性。
