Bernardes Thomas P, Mol Ben W, Ravelli Anita C J, van den Berg Paul P, Boezen H Marike, Groen Henk
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
Obstetrics and Gynaecology, Monash University, Scenic Blvd & Wellington Road, Clayton, VIC 3800, Australia.
Pregnancy Hypertens. 2019 Jan;15:32-36. doi: 10.1016/j.preghy.2018.10.010. Epub 2018 Nov 2.
To estimate preeclampsia occurrence and recurrence risk in the 2nd pregnancy and analyze associated risk factors such as 1st pregnancy maximum diastolic blood pressure (maxDBP) and gestational age at delivery (GA).
Linked cohort of 1st and 2nd pregnancies of 272,551 women from the Dutch Perinatal Registry collected between 2000 and 2007. We defined preeclampsia as hypertension (maxDBP ≥90 mmHg or documented hypertension) plus proteinuria (≥300 mg/24 h) and analyzed its 2nd pregnancy occurrence with logistic regression. Early and late onset preeclampsia were defined by delivery before and after the 34th week, respectively.
Preeclampsia prevalences in the 1st and 2nd pregnancies were 2.5% and 0.9%, respectively. Women with prior preeclampsia had a 10.5% risk of recurrence. For women with term 1st pregnancies and maxDBP <80 mmHg, the 2nd pregnancy preeclampsia rate was 0.2% (95% CI 0.17%-0.23%), while for those whom presented maxDBP ≥110 mmHg it was 4.2% (95% CI 3.6%-4.8%). First pregnancy late onset preeclampsia was associated with increased preeclampsia recurrence risk proportional to 1st pregnancy maxDBP: in women with a maxDBP between 100 and 109 mmHg the recurrence risk was 8.3%, while for women with a maxDBP ≥110 mmHg this risk was 11% (difference 2.7%; 95% CI 1.0%-4.4%). In 1st pregnancy early onset preeclampsia corresponding rates were 14.8% and 19.3% (difference 4.5%; 95% CI -1.3%-9.7%).
Preeclampsia recurrence risk is 10%. Preeclampsia risk in the 2nd pregnancy increases proportionally to 1st pregnancy maxDBP. Earlier onsets of 1st pregnancy preeclampsia further increase recurrence risk.
评估子痫前期在第二次妊娠中的发生率及复发风险，并分析相关风险因素，如首次妊娠时的最高舒张压（maxDBP）和分娩时的孕周（GA）。
对2000年至2007年间荷兰围产期登记处收集的272551名女性的首次和第二次妊娠进行队列关联研究。我们将子痫前期定义为高血压（maxDBP≥90mmHg或有记录的高血压）加蛋白尿（≥300mg/24h），并通过逻辑回归分析其在第二次妊娠中的发生率。早发型和晚发型子痫前期分别定义为在第34周之前和之后分娩。
首次妊娠和第二次妊娠中的子痫前期患病率分别为2.5%和0.9%。有子痫前期病史的女性复发风险为10.5%。对于首次妊娠足月且maxDBP<80mmHg的女性，第二次妊娠子痫前期发生率为0.2%（95%CI 0.17%-0.23%），而对于maxDBP≥110mmHg的女性，该发生率为4.2%（95%CI 3.6%-4.8%）。首次妊娠晚发型子痫前期与子痫前期复发风险增加相关，且与首次妊娠maxDBP成比例：maxDBP在100至109mmHg之间的女性复发风险为8.3%，而maxDBP≥110mmHg的女性复发风险为11%（差异2.7%；95%CI 1.0%-4.4%）。在首次妊娠早发型子痫前期中，相应的发生率分别为14.8%和19.3%（差异4.5%；95%CI -1.3%-9.7%）。
子痫前期复发风险为10%。第二次妊娠子痫前期风险与首次妊娠maxDBP成比例增加。首次妊娠子痫前期发病越早，复发风险越高。
