Hauspurg Alisse, Countouris Malamo E, Jeyabalan Arun, Hubel Carl A, Roberts James M, Schwarz Eleanor B, Catov Janet M
Department of Obstetrics, Gynecology and Reproductive Sciences, Univeristy of Pittsburgh School of Medicine, United States; Magee-Womens Research Institute, University of Pittsburgh, United States.
University of Pittsburgh Medical Center Heart and Vascular Institute, United States.
Pregnancy Hypertens. 2019 Jan;15:1-6. doi: 10.1016/j.preghy.2018.10.009. Epub 2018 Nov 2.
Hypertension and obesity are common cardiometabolic risk factors in reproductive age women. The association of hypertensive disorders of pregnancy with later-life cardiovascular disease is well-established, however, it is unknown how obesity and hypertensive disorders of pregnancy converge to accelerate development of hypertension in the postpartum period. The aim of this study was to characterize rates of sustained hypertension at one year postpartum using the new American Heart Association/American College of Cardiology Guidelines among overweight and obese women with a normotensive pregnancy or hypertensive disorder of pregnancy.
315 early pregnant women were enrolled prospectively and followed up to 12 months after delivery (mean 7.0 ± 1.8 months). At a postpartum research visit, we measured blood pressure and collected blood samples to measure cystatin C and high sensitivity C-reactive protein.
A total of 254 women had a normotensive pregnancy, 39 had gestational hypertension (12.4%) and 22 had preeclampsia (7.0%). 91 women had hypertension at the postpartum study visit (28.9%). After adjustment for maternal age, BMI, lactation and time postpartum, preeclampsia was associated with an aOR 2.35 (95%CI 1.63-3.41) of development of sustained hypertension and an aOR 3.23 (95%CI 1.56-6.68) of hypertension with abnormal biomarkers compared to women with normotensive pregnancies.
We demonstrate a high prevalence of hypertension and abnormal biomarkers associated with hypertensive disorders of pregnancy among overweight and obese women. Our findings support the need for structured follow up and risk reduction in overweight and obese women with hypertensive disorders of pregnancy as early as the first year postpartum.
高血压和肥胖是育龄期女性常见的心脏代谢危险因素。妊娠高血压疾病与晚年心血管疾病之间的关联已得到充分证实，然而，肥胖与妊娠高血压疾病如何共同作用加速产后高血压的发展尚不清楚。本研究的目的是利用美国心脏协会/美国心脏病学会的新指南，对血压正常的妊娠或妊娠高血压疾病的超重和肥胖女性产后一年的持续性高血压发生率进行特征描述。
前瞻性纳入315名早期孕妇，并随访至产后12个月（平均7.0±1.8个月）。在产后研究访视时，我们测量了血压并采集血样以检测胱抑素C和高敏C反应蛋白。
共有254名女性血压正常妊娠，39名患有妊娠期高血压（12.4%），22名患有先兆子痫（7.0%）。91名女性在产后研究访视时患有高血压（28.9%）。在调整了产妇年龄、体重指数、哺乳和产后时间后，与血压正常妊娠的女性相比，先兆子痫与持续性高血压发生的调整后比值比为2.35（95%可信区间1.63 - 3.41），与生物标志物异常的高血压的调整后比值比为3.23（95%可信区间1.56 - 6.68）。
我们证明了超重和肥胖女性中与妊娠高血压疾病相关的高血压和异常生物标志物的高患病率。我们的研究结果支持对患有妊娠高血压疾病的超重和肥胖女性在产后第一年尽早进行结构化随访和降低风险的必要性。
