Department of Medicine, University of California, San Francisco, California.
Department of Medicine, University of California, San Francisco, California; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Am J Cardiol. 2020 Sep 15;131:17-22. doi: 10.1016/j.amjcard.2020.06.034. Epub 2020 Jun 30.
Complications of pregnancy present an opportunity to identify women at high risk of cardiovascular disease (CVD). Placental abruption is a severe and understudied pregnancy complication, and its relationship with CVD is poorly understood. The California Healthcare Cost and Utilization Project database was used to identify women with hospitalized pregnancies in California between 2005 and 2009, with follow-up through 2011. Pregnancies, exposures, covariates, and outcomes were defined by International Classification of Diseases Ninth Revision codes. Cox proportional-hazards regression was used to examine the association between placental abruption and myocardial infarction (MI), stroke, and heart failure (HF). Multivariate models controlling for age, race, medical co-morbidities, pregnancy complications, psychiatric and substance use disorders, and socioeconomic factors were employed. Among over 1.5 million pregnancies, placental abruption occurred in 14,881 women (1%). Median follow-up time from delivery to event or censoring was 4.87 (interquartile range 3.54 to 5.96) years. In unadjusted models, placental abruption was associated with risk of HF, but not MI or stroke. In fully-adjusted models, placental abruption remained significantly associated with HF (Hazard ratio 1.44; 95% confidence interval 1.09 to 1.90). Among women with placental abruptions, hypertensive disorders of pregnancy and preterm birth respectively modified and mediated the association between placental abruption and HF. In conclusion, placental abruption is a risk factor for HF, particularly in women who also experience hypertensive disorders of pregnancy and preterm birth. Placental abruption is a specific adverse pregnancy outcome associated with risk of HF.
妊娠并发症为识别心血管疾病（CVD）高危女性提供了机会。胎盘早剥是一种严重且研究不足的妊娠并发症，其与 CVD 的关系尚不清楚。本研究使用加利福尼亚医疗保健成本和利用项目数据库，确定了 2005 年至 2009 年加利福尼亚州住院妊娠的女性，并随访至 2011 年。妊娠、暴露、协变量和结局均由国际疾病分类第九版代码定义。使用 Cox 比例风险回归分析胎盘早剥与心肌梗死（MI）、中风和心力衰竭（HF）之间的关系。采用多变量模型控制年龄、种族、合并症、妊娠并发症、精神和物质使用障碍以及社会经济因素。在超过 150 万例妊娠中，有 14881 例（1%）发生胎盘早剥。从分娩到事件或删失的中位随访时间为 4.87 年（四分位距 3.54 至 5.96）。在未调整模型中，胎盘早剥与 HF 风险相关，但与 MI 或中风无关。在完全调整的模型中，胎盘早剥与 HF 仍显著相关（风险比 1.44；95%置信区间 1.09 至 1.90）。在胎盘早剥的女性中，妊娠高血压疾病和早产分别修饰和介导了胎盘早剥与 HF 之间的关系。总之，胎盘早剥是 HF 的危险因素，尤其是在患有妊娠高血压疾病和早产的女性中。胎盘早剥是与 HF 风险相关的特定不良妊娠结局。
