El-Qatrawi Khalil Jamil
Deir-Balah Health Center-UNRWA, Deir El-Balah Camp, Gaza, occupied Palestinian territory.
Lancet. 2021 Jul;398 Suppl 1:S26. doi: 10.1016/S0140-6736(21)01512-9.
Hypertensive disorders affect 10% of all pregnant women and increase the risk of adverse maternal and neonatal outcomes and the psychological wellbeing and quality of life of women. This study is to the best of my knowledge the first to investigate these issues in the Gaza Strip. I compared adverse effects in pregnancy between hypertensive and non-hypertensive women.
In this comparative study, eligible participants were hypertensive and non-hypertensive women attending health centres for postnatal care between August, 2016, and May, 2017. Six UNRWA health centres of 21 in Gaza Strip were selected randomly and quota sampling was applied after written informed consent was obtained. Data were collected by face-to-face interview and completion of the WHOQOL-BREF scale and SF-36 to assess quality of life. Additionally, data were extracted from patients' electronic primary medical records. Differences were analysed with Student's t test and the χ test, using SPSS version 22.
430 mothers were enrolled, including 215 with hypertension and 215 without. Mean age was 28·0 years (SD 6·15). The mean gravidity and parity were 4·3 and 3·4, respectively, in the hypertensive group and 3·6 and 2·7 in the non-hypertensive group. Compared with the non-hypertensive group, the hypertensive group had a greater mean body-mass index (30·7 kg/mvs 25·8 kg/m), number of antenatal care visits (8·6 vs 6·6), and rate of pre-eclampsia (29%). 45 (21%) women in the hypertensive group had persistent hypertension after the postnatal period. Hypertensive mothers had higher rates of caesarean section (80 [37%] vs 35 [16%], p=0·001), delivery induction (58 [27%] vs 18 [8%], p=0·001). antepartum haemorrhage (30 [14%] vs six [3%], p=0·001), and postpartum haemorrhage (15 [7%] vs three [1·4%], p=0·003). Neonates born to women in the hypertensive group were at increased risk of having preterm birth (32 [15%] of 213 vs 16 [8%] of 215, p=0·013), low birthweight (21 [10%] vs 6 [3%], p=0·003), and neonatal admissions (26 [13%] vs 14 [7%], p=0·044) compared with those born to women in the non-hypertensive group. Hypertensive mothers had a lower mean quality of life score than women in the non-hypertensive group (64·2 vs 71·3, p=0·001).
Neonatal admission in the hypertensive group and the caesarean section rates were lower than expected given the rates of preterm birth and low birthweight. These findings might be attributed to inadequate specialised management due to limited resources, blockade, receiving specialist treatment outside Gaza Strip, and political context. However, higher number of antenatal care visits suggests that hypertensive women receive more antenatal care from health-care providers at UNRWA clinics than non-hypertensive women. Secondary and tertiary maternal care in Gaza Strip need to be improved. A limitation of this study was poor documentation of some secondary health care data in electronic primary medical records but was overcome by reviewing hospital records.
None.
高血压疾病影响着10%的孕妇，增加了孕产妇和新生儿不良结局的风险，以及女性的心理健康和生活质量。据我所知，本研究是首次在加沙地带调查这些问题。我比较了高血压孕妇和非高血压孕妇在孕期的不良反应。
在这项比较研究中，符合条件的参与者为2016年8月至2017年5月期间在保健中心接受产后护理的高血压和非高血压女性。从加沙地带21个联合国近东巴勒斯坦难民救济和工程处（UNRWA）保健中心中随机选择6个，并在获得书面知情同意后采用配额抽样。通过面对面访谈以及填写世界卫生组织生活质量简表（WHOQOL-BREF）和36项简短健康调查量表（SF-36）来收集数据，以评估生活质量。此外，从患者的电子初级医疗记录中提取数据。使用SPSS 22版软件，通过学生t检验和χ检验分析差异。
共纳入430名母亲，其中215名患有高血压，215名未患高血压。平均年龄为28.0岁（标准差6.15）。高血压组的平均妊娠次数和产次分别为4.3和3.4，非高血压组分别为3.6和2.7。与非高血压组相比，高血压组的平均体重指数更高（30.7kg/m²对25.8kg/m²）、产前检查次数更多（8.6次对6.6次）、子痫前期发生率更高（29%）。高血压组中有45名（21%）女性在产后仍患有持续性高血压。高血压母亲的剖宫产率更高（80例[37%]对35例[16%]，p = 0.001）、引产率更高（58例[27%]对18例[8%]，p = 0.001）、产前出血率更高（30例[14%]对6例[3%]，p = 0.001）以及产后出血率更高（15例[7%]对3例[1.4%]，p = 0.003）。与非高血压组女性所生新生儿相比，高血压组女性所生新生儿早产风险增加（213例中有32例[15%]对215例中有16例[8%]，p = 0.013）、低出生体重风险增加（21例[10%]对6例[3%]，p = 0.003）以及新生儿入院风险增加（26例[13%]对14例[7%]，p = 0.044）。高血压母亲的平均生活质量得分低于非高血压组女性（64.2对71.3，p = 0.001）。
鉴于早产和低出生体重率，高血压组的新生儿入院率和剖宫产率低于预期。这些发现可能归因于资源有限、封锁、在加沙地带以外接受专科治疗以及政治环境导致的专科管理不足。然而，产前检查次数较多表明，与非高血压女性相比，高血压女性从联合国近东巴勒斯坦难民救济和工程处诊所的医疗保健提供者那里获得了更多的产前护理。加沙地带的二级和三级孕产妇护理需要改善。本研究的一个局限性是电子初级医疗记录中一些二级医疗保健数据记录不完善，但通过查阅医院记录得以克服。
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