Division of Obstetrics and Gynaecology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
BJOG. 2020 Aug;127(9):1090-1099. doi: 10.1111/1471-0528.16201. Epub 2020 Mar 31.
To investigate the association between a history of placental bed disorders and later dementia.
Retrospective population-based cohort study.
Sweden.
All women giving birth in Sweden between 1973 and 1993 (1 128 709).
Women with and without placental bed disorders (hypertensive disorders of pregnancy including pre-eclampsia, fetal growth restriction, spontaneous preterm labour and birth, preterm premature rupture of membranes, abruptio placenta, late miscarriages) and other pregnancy complications were identified by means of the Swedish Medical Birth Register. International classification of disease was used. Data were linked to other National Registers. Participants were followed up until 2013. The Cox proportional hazards model was used to calculate hazard ratios for women with and without pregnancy complications and were adjusted for possible confounders.
Diagnosis of vascular dementia and non-vascular dementia.
Adjusted for cardiovascular disease and socio-demographic factors, an increased risk of vascular dementia was shown in women with previous pregnancy-induced hypertension (Hazard ratio [HR] 1.88, 95% CI 1.32-2.69), pre-eclampsia (HR 1.63, 95% CI 1.23-2.16), spontaneous preterm labour and birth (HR 1.65, 95% CI 1.12-2.42) or preterm premature rupture of membranes (HR 1.60, 95% CI 1.08-2.37). No statistically significant increased risk was seen for other pregnancy complications or non-vascular dementia even though many of the point estimates indicated increased risks.
Women with placental bed disorders have a higher risk for vascular disease. Mechanisms behind the abnormal placentation remain elusive, although maternal constitutional factors, abnormal implantation as well as impaired angiogenesis have been suggested.
Placental bed syndromes associated with vascular dementia even after adjusting for cardiovascular disease.
探讨胎盘床疾病史与迟发性痴呆的关系。
基于人群的回顾性队列研究。
瑞典。
1973 年至 1993 年期间在瑞典分娩的所有妇女（1 128 709 人）。
通过瑞典医学出生登记处确定患有胎盘床疾病（包括子痫前期、胎儿生长受限、自发性早产和分娩、早产胎膜早破、胎盘早剥、晚期流产）和其他妊娠并发症的妇女和无胎盘床疾病（高血压疾病）的妇女。使用国际疾病分类。数据与其他国家登记册相关联。对参与者进行随访，直至 2013 年。使用 Cox 比例风险模型计算有和无妊娠并发症的女性的风险比，并针对可能的混杂因素进行调整。
血管性痴呆和非血管性痴呆的诊断。
调整心血管疾病和社会人口因素后，有先前妊娠高血压（危险比 [HR] 1.88，95%置信区间 1.32-2.69）、子痫前期（HR 1.63，95%置信区间 1.23-2.16）、自发性早产和分娩（HR 1.65，95%置信区间 1.12-2.42）或早产胎膜早破（HR 1.60，95%置信区间 1.08-2.37）的妇女发生血管性痴呆的风险增加。尽管许多点估计表明风险增加，但其他妊娠并发症或非血管性痴呆的风险未见统计学显著增加。
患有胎盘床疾病的妇女患血管疾病的风险更高。虽然母体构成因素、异常着床以及血管生成受损等因素已被提出，但异常胎盘形成背后的机制仍不清楚。
即使在调整心血管疾病后，胎盘床综合征与血管性痴呆相关。
