Wainstock Tamar, Sergienko Ruslan, Sheiner Eyal
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel.
J Clin Med. 2020 Apr 13;9(4):1103. doi: 10.3390/jcm9041103.
The incidence of preeclampsia, which may cause significant maternal and perinatal morbidity, has risen in recent years, therefore it is critical to identify women at risk for preeclampsia. We aimed to identify risk factors in the first pregnancy (not complicated by preeclampsia) for preeclampsia in the subsequent pregnancy.
A retrospective population-based nested case-control study was conducted, including all women with first (P1) and second (P2) singleton consecutive deliveries. Women who had experienced preeclampsia in their first pregnancy were excluded. Cases were defined as women with preeclampsia in their second pregnancy, and were compared to the controls, defined as women without this diagnosis in second pregnancy. Characteristics and complications of the first pregnancy were compared between cases and controls, and multivariable regression models were used to study the association between pregnancy complications (in the first pregnancy) and preeclampsia (in the subsequent pregnancy), while adjusting for confounders.
A total of 40,673 women were included in the study, 1.5% of second pregnancies were diagnosed with preeclampsia ( = 627, i.e., Cases). Cases, as compared to controls were older in their 1st pregnancy, with longer inter-pregnancy interval, and were more likely to have the following complications in their first pregnancy: preterm delivery (15.0% vs. 7.7%), low birthweight (17.9% vs. 10.3%), perinatal mortality (3.2% vs. 1.1%), and gestational diabetes (7.0% vs. 2.7%). In the multivariable model, adjusted for maternal age, obesity and inter-pregnancy interval, either one of these first pregnancy complications were independently associated with an increased risk for preeclampsia (adjusted OR for either of first pregnancy complication =1.73; 95% CI 1.37-2.14, <0.001), and the risk was greater for each additional complication (adjusted OR for ≥2 risk factors =3.54; 95% CI 2.28-5.52, < 0.001).
Complications in first pregnancy, including preterm delivery, perinatal mortality and gestational diabetes, are risk factors for primary preeclampsia in second pregnancy. First pregnancy may serve as a window of opportunity to identify women at risk for future preeclampsia and other morbidities later in life.
近年来，可能导致严重孕产妇和围产期发病的子痫前期发病率有所上升，因此识别子痫前期高危女性至关重要。我们旨在确定首次妊娠（无子痫前期并发症）时发生子痫前期的危险因素，以便预测后续妊娠发生子痫前期的风险。
进行了一项基于人群的回顾性巢式病例对照研究，纳入所有首次（P1）和第二次（P2）单胎连续分娩的女性。排除首次妊娠时发生子痫前期的女性。病例定义为第二次妊娠发生子痫前期的女性，对照定义为第二次妊娠未诊断出子痫前期的女性。比较病例组和对照组首次妊娠的特征和并发症，并使用多变量回归模型研究妊娠并发症（首次妊娠时）与子痫前期（后续妊娠时）之间的关联，同时对混杂因素进行校正。
共纳入40673名女性，1.5%的第二次妊娠被诊断为子痫前期（n = 627，即病例组）。与对照组相比，病例组首次妊娠时年龄更大，妊娠间隔更长，首次妊娠时更易出现以下并发症：早产（15.0% vs. 7.7%）、低出生体重（17.9% vs. 10.3%）、围产期死亡率（3.2% vs. 1.1%）和妊娠期糖尿病（7.0% vs. 2.7%）。在多变量模型中，校正产妇年龄、肥胖和妊娠间隔后，首次妊娠的任何一种并发症均与子痫前期风险增加独立相关（首次妊娠任何一种并发症的校正OR = 1.73；95% CI 1.37 - 2.14，P < 0.001），且每增加一种并发症风险更高（≥2个危险因素的校正OR = 3.54；95% CI 2.28 - 5.52，P < 0.001）。
首次妊娠的并发症，包括早产、围产期死亡率和妊娠期糖尿病，是第二次妊娠发生子痫前期的危险因素。首次妊娠可作为识别未来子痫前期及其他后期发病高危女性的机会窗口。
