Antenatal Hypertension Clinic, Fetal Medicine Research Institution, King's College Hospital, London, UK.
Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
Acta Obstet Gynecol Scand. 2021 Jul;100(7):1297-1304. doi: 10.1111/aogs.14132. Epub 2021 Mar 17.
The aim of this study was to assess perinatal outcomes in women with chronic hypertension (CH) stratified into four groups according to their blood pressure (BP) control in the first trimester of pregnancy.
This was a prospective cohort study between January 2011 and June 2017, based in a university hospital in London, UK. The population consisted of four groups: group 1 included women without history of CH, presenting in the first trimester with BP >140/90 mmHg (n = 100). Groups 2-4 had prepregnancy CH; group 2 had BP <140/90 mmHg without antihypertensives (n = 234), group 3 had BP <140/90 mmHg with antihypertensives (n = 272), and group 4 had BP ≥140/90 mmHg despite antihypertensives (n = 194). The main outcome measures were: fetal growth restriction, admission to neonatal (NNU) or neonatal intensive care unit (NICU) for ≥2 days, composite neonatal morbidity, and composite serious adverse neonatal outcome. Outcomes were collected from the hospital databases and for up to 6 weeks postnatally. Differences between groups were assessed using chi-squared test and multivariate logistic regression was used to assess the independent contribution of the four groups to the prediction of pertinent outcomes, after controlling for maternal characteristics.
There was a higher incidence of fetal growth restriction in groups 3 (17.6%) and 4 (18.2%), compared with groups 1 (10.0%) and 2 (11.1%) (P = .04). There were more admissions to the NNU for ≥2 days in groups 3 (23.2%) and 4 (25.0%), compared with groups 1 (17.0%) and 2 (13.2%) (P = .008); and more admissions to NICU for ≥2 days in groups 3 (9.2%) and 4 (9.4%), compared with groups 1 (3.0%) and 2 (3.4%) (P = .01). Composite neonatal morbidity was higher in groups 3 (22.4%) and 4 (21.4%), compared with groups 1 (17.0%) and 2 (11.5%) (P = .009). Composite serious adverse postnatal outcome was higher in groups 3 (3.3%) and 4 (4.2%), compared with groups 1 (1.0%) and 2 (0.9%) but the difference did not reach statistical significance (P = .09). These results were also observed when values were adjusted for maternal characteristics.
In CH adverse perinatal outcomes are worse in women who are known to have CH and need antihypertensives in the first trimester of pregnancy. Women with newly diagnosed CH in the first trimester have similar outcomes to those with known CH who have antihypertensive treatment discontinued.
本研究旨在评估根据孕早期血压控制情况将患有慢性高血压（CH）的女性分为四组的围产期结局。
这是一项 2011 年 1 月至 2017 年 6 月间在英国伦敦一所大学医院进行的前瞻性队列研究。该人群包括四组：第 1 组包括无 CH 病史的女性，在孕早期出现血压>140/90mmHg（n=100）；第 2-4 组为孕前患有 CH 的患者；第 2 组为血压<140/90mmHg 且未服用降压药（n=234）；第 3 组为血压<140/90mmHg 且服用降压药（n=272）；第 4 组为即使服用降压药血压仍≥140/90mmHg（n=194）。主要结局指标包括：胎儿生长受限、新生儿（NNU）或新生儿重症监护病房（NICU）住院≥2 天、复合新生儿发病率和复合严重不良新生儿结局。从医院数据库中收集结局，并在产后 6 周内进行随访。使用卡方检验评估组间差异，采用多变量逻辑回归在控制母体特征后评估四组对相关结局的独立预测作用。
第 3 组（17.6%）和第 4 组（18.2%）胎儿生长受限的发生率高于第 1 组（10.0%）和第 2 组（11.1%）（P=0.04）。第 3 组（23.2%）和第 4 组（25.0%）NNU 住院≥2 天的患者多于第 1 组（17.0%）和第 2 组（13.2%）（P=0.008）；第 3 组（9.2%）和第 4 组（9.4%）NICU 住院≥2 天的患者多于第 1 组（3.0%）和第 2 组（3.4%）（P=0.01）。第 3 组（22.4%）和第 4 组（21.4%）的新生儿复合发病率高于第 1 组（17.0%）和第 2 组（11.5%）（P=0.009）。第 3 组（3.3%）和第 4 组（4.2%）的复合严重不良产后结局高于第 1 组（1.0%）和第 2 组（0.9%），但差异无统计学意义（P=0.09）。当调整母体特征时，也观察到了这些结果。
在 CH 中，已知患有 CH 且在孕早期需要降压药的女性发生不良围产期结局的风险更高。在孕早期新诊断为 CH 的女性与停用降压药的已知 CH 女性具有相似的结局。
