Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, the Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, the Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung City, the Division of Gastroenterology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, the Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, the Emergency Department, Shuang Ho Hospital, Taipei Medical University, New Taipei City, the Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, the Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli County, the Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, and the Department of Dentistry and Department of Medical Research, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Obstet Gynecol. 2021 Feb 1;137(2):285-293. doi: 10.1097/AOG.0000000000004277.
To assess the association between hypertensive disorders of pregnancy and adverse events after pregnancy, including chronic kidney disease and major adverse cardiovascular events (cerebrovascular accident, coronary artery disease, or death).
A nationwide, population-based cohort study was conducted analyzing women with hypertensive disorders of pregnancy identified from Taiwan National Health Insurance Research Database from 2004 to 2015. Hypertensive disorders of pregnancy were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. The study cohort was comprised of women aged 20-40 years diagnosed with hypertensive disorders of pregnancy from 2006 to 2013. The comparison group comprised of four randomly selected women without hypertensive disorders of pregnancy, matched for age and index date for each woman with hypertensive disorders of pregnancy. All the women were followed from the date of cohort entry until they developed chronic kidney disease or major adverse cardiovascular events or until the end of 2015, whichever occurred first. A Cox proportional hazard model was used to estimate the risk of chronic kidney disease and major adverse cardiovascular events.
We identified 29,852 women with a diagnosis of hypertensive disorders of pregnancy and 119,408 matched women without hypertensive disorders of pregnancy who fit the inclusion criteria. The crude hazard ratios (HRs) were 5.22 (95% CI 4.67-5.83) and 2.26 (95% CI 1.99-2.57) for chronic kidney disease and major adverse cardiovascular events. After adjusting for potential confounders, hypertensive disorders of pregnancy was associated with a higher risk of chronic kidney disease (adjusted HR, 4.26; 95% CI 3.80-4.78), and major adverse cardiovascular events (adjusted HR, 2.15; 95% CI 1.89-2.45).
This population-based cohort study indicated that women with hypertensive disorders of pregnancy are at a higher risk of chronic kidney disease and major adverse cardiovascular events than women without hypertensive disorders of pregnancy. Further studies are required to clarify the nature of these associations and to improve public health interventions.
评估妊娠高血压疾病与妊娠后不良事件（包括慢性肾脏病和主要不良心血管事件[脑血管意外、冠状动脉疾病或死亡]）之间的关联。
进行了一项全国性、基于人群的队列研究，分析了来自台湾全民健康保险研究数据库的 2004 年至 2015 年期间患有妊娠高血压疾病的女性。使用国际疾病分类，第九修订版，临床修正代码来识别妊娠高血压疾病。研究队列由 2006 年至 2013 年期间被诊断为妊娠高血压疾病的 20-40 岁女性组成。对照组由 4 名随机选择的无妊娠高血压疾病的女性组成，与每位患有妊娠高血压疾病的女性的年龄和指数日期相匹配。所有女性从队列进入日期开始随访，直到发生慢性肾脏病或主要不良心血管事件，或直至 2015 年底，以先发生者为准。使用 Cox 比例风险模型来估计慢性肾脏病和主要不良心血管事件的风险。
我们确定了 29852 名患有妊娠高血压疾病的女性和 119408 名符合纳入标准的无妊娠高血压疾病的匹配女性。未经调整的风险比（HR）分别为 5.22（95%CI 4.67-5.83）和 2.26（95%CI 1.99-2.57）用于慢性肾脏病和主要不良心血管事件。在调整潜在混杂因素后，妊娠高血压疾病与慢性肾脏病（调整 HR，4.26；95%CI 3.80-4.78）和主要不良心血管事件（调整 HR，2.15；95%CI 1.89-2.45）的风险增加相关。
这项基于人群的队列研究表明，患有妊娠高血压疾病的女性发生慢性肾脏病和主要不良心血管事件的风险高于无妊娠高血压疾病的女性。需要进一步研究来阐明这些关联的性质，并改善公共卫生干预措施。
