Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Epidemiology, University of Iowa, Iowa City, Iowa, USA.
BMJ Open. 2020 Jun 3;10(6):e034145. doi: 10.1136/bmjopen-2019-034145.
To determine whether maternal cardiovascular disease (CVD) risk factors predict preterm birth.
Case control.
California hospitals.
868 mothers with linked demographic information and biospecimens who delivered singleton births from July 2009 to December 2010.
Logistic regression analysis was employed to calculate odds ratios for the associations between maternal CVD risk factors before and during pregnancy (including diabetes, hypertensive disorders and cholesterol levels) and preterm birth outcomes.
Preterm delivery status.
Adjusting for the other maternal CVD risk factors of interest, all categories of hypertension led to increased odds of preterm birth, with the strongest magnitude observed in the pre-eclampsia group (adjusted OR (aOR), 13.49; 95% CI 6.01 to 30.27 for preterm birth; aOR, 10.62; 95% CI 4.58 to 24.60 for late preterm birth; aOR, 17.98; 95% CI 7.55 to 42.82 for early preterm birth) and chronic hypertension alone for early preterm birth (aOR, 4.58; 95% CI 1.40 to 15.05). Diabetes (types 1 and 2 and gestational) was also associated with threefold increased risk for preterm birth (aOR, 3.06; 95% CI 1.12 to 8.41). A significant and linear dose response was found between total and low-density lipoprotein (LDL) cholesterol and aORs for late and early preterm birth, with increasing cholesterol values associated with increased risk (likelihood χ differences of 8.422 and 8.019 for total cholesterol for late and early, and 9.169 and 10.896 for LDL for late and early, respectively). Receiver operating characteristic curves using these risk factors to predict late and early preterm birth produced C statistics of 0.601 and 0.686.
Traditional CVD risk factors are significantly associated with an increased risk of preterm birth; these findings reinforce the clinical importance of integrating obstetric and cardiovascular risk assessment across the healthcare continuum in women.
确定母体心血管疾病（CVD）危险因素是否可预测早产。
病例对照研究。
加利福尼亚州的医院。
868 名母亲，她们的人口统计学信息和生物样本与 2009 年 7 月至 2010 年 12 月期间的单胎分娩有关。
采用逻辑回归分析计算母体 CVD 危险因素（包括糖尿病、高血压疾病和胆固醇水平）与早产结局之间的比值比。
早产状态。
调整了其他感兴趣的母体 CVD 危险因素后，所有类别的高血压均导致早产的几率增加，其中子痫前期组的幅度最大（早产的校正比值比（aOR）为 13.49；95%CI 6.01 至 30.27；晚早产的 aOR 为 10.62；95%CI 4.58 至 24.60；早产的 aOR 为 17.98；95%CI 7.55 至 42.82），而慢性高血压单独与早产有关（aOR 为 4.58；95%CI 1.40 至 15.05）。糖尿病（1 型、2 型和妊娠期）也与早产风险增加三倍相关（aOR 为 3.06；95%CI 1.12 至 8.41）。总胆固醇和低密度脂蛋白（LDL）胆固醇与晚早产和早产的 aOR 之间存在显著的线性剂量反应，胆固醇值升高与风险增加相关（总胆固醇晚早产和早产的似然 χ 差异分别为 8.422 和 8.019，LDL 晚早产和早产的似然 χ 差异分别为 9.169 和 10.896）。使用这些危险因素预测晚早产和早产的受试者工作特征曲线产生的 C 统计量分别为 0.601 和 0.686。
传统的 CVD 危险因素与早产风险增加显著相关；这些发现强调了在女性整个医疗保健过程中整合产科和心血管风险评估的临床重要性。
