母亲在患有妊娠高血压疾病的双胞胎妊娠后的心血管疾病：基于人群的队列研究。
Maternal cardiovascular disease after twin pregnancies complicated by hypertensive disorders of pregnancy: a population-based cohort study.
机构信息
Division of Maternal-Fetal Medicine (Hiersch, Barrett, Melamed), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Departments of Obstetrics and Gynaecology (Hiersch), Lis Maternity Hospital and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Departments of Medicine and Obstetrics and Gynaecology (Ray), St. Michael's Hospital, University of Toronto; ICES Central (Ray, Diong, Gandhi, Guan); Division of Maternal-Fetal Medicine (Berger, Geary), Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Maternal-Fetal Medicine (McDonald, Murray-Davis), Departments of Obstetrics and Gynecology, Radiology, and Research Methods, Evidence & Impact, McMaster University, Hamilton, Ont.
出版信息
CMAJ. 2021 Sep 20;193(37):E1448-E1458. doi: 10.1503/cmaj.202837.
BACKGROUND
People whose singleton pregnancy is affected by hypertensive disorders of pregnancy (HDP) are at risk of future cardiovascular disease. It is unclear, however, whether this association can be extrapolated to twin pregnancies. We aimed to compare the association between HDP and future cardiovascular disease after twin and singleton pregnancies.
METHODS
We conducted a population-based retrospective cohort study that included nulliparous people in Ontario, Canada, 1992-2017. We compared the future risk of cardiovascular disease among pregnant people from the following 4 groups: those who delivered a singleton without HDP (referent) and with HDP, and those who delivered twins either with or without HDP.
RESULTS
The populations of the 4 groups were as follows: 1 431 651 pregnant people in the singleton birth without HDP group; 98 631 singleton birth with HDP; 21 046 twin birth without HDP; and 4283 twin birth with HDP. The median duration of follow-up was 13 (interquartile range 7-20) years. The incidence rate of cardiovascular disease was lowest among those with a singleton or twin birth without HDP (0.72 and 0.74 per 1000 person-years, respectively). Compared with people with a singleton birth without HDP, the risk of cardiovascular disease was highest among those with a singleton birth and HDP (1.47 per 1000 person-years; adjusted hazard ratio [HR] 1.81 [95% confidence interval (CI) 1.72-1.90]), followed by people with a twin pregnancy and HDP (1.07 per 1000 person-years; adjusted HR 1.36 [95% CI 1.04-1.77]). The risk of the primary outcome after a twin pregnancy with HDP was lower than that after a singleton pregnancy with HDP (adjusted HR 0.74 [95% CI 0.57-0.97]), when compared directly.
INTERPRETATION
In a twin pregnancy, HDP are weaker risk factors for postpartum cardiovascular disease than in a singleton pregnancy.
背景
患有妊娠高血压疾病（HDP）的单胎妊娠患者未来发生心血管疾病的风险增加。然而，尚不清楚这种关联是否可以外推至双胎妊娠。本研究旨在比较 HDP 对双胎和单胎妊娠后未来心血管疾病的影响。
方法
我们进行了一项基于人群的回顾性队列研究，纳入了加拿大安大略省 1992 年至 2017 年间的初产妇。我们比较了以下 4 组孕妇的未来心血管疾病风险：无 HDP 的单胎分娩（参照组）和有 HDP 的单胎分娩，以及无 HDP 的双胎分娩和有 HDP 的双胎分娩。
结果
4 组人群如下：无 HDP 的单胎分娩组 1431651 例，有 HDP 的单胎分娩组 98631 例，无 HDP 的双胎分娩组 21046 例，有 HDP 的双胎分娩组 4283 例。中位随访时间为 13 年（四分位距 7-20 年）。无 HDP 的单胎或双胎分娩患者的心血管疾病发生率最低（分别为 0.72 和 0.74/1000 人年）。与无 HDP 的单胎分娩患者相比，有 HDP 的单胎分娩患者的心血管疾病风险最高（1.47/1000 人年；调整后的 HR 1.81 [95%CI 1.72-1.90]），其次是有 HDP 的双胎分娩患者（1.07/1000 人年；调整后的 HR 1.36 [95%CI 1.04-1.77]）。与有 HDP 的单胎妊娠相比，有 HDP 的双胎妊娠患者发生主要结局的风险较低（直接比较时，调整后的 HR 0.74 [95%CI 0.57-0.97]）。
解释
在双胎妊娠中，HDP 是产后心血管疾病的风险因素弱于单胎妊娠。
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