Miller Eliza C, Carper Benjamin, Bello Natalie A, Bairey Merz C Noel, Greenland Philip, Levine Lisa D, Haas David M, Grobman William A, McNeil Rebecca B, Chung Judith H, Jolley Jennifer, Saade George R, Silver Robert M, Simhan Hyagriv N, Wapner Ronald J, Parker Corette B
Department of Neurology, Division of Stroke and Cerebrovascular Disease, Columbia University Vagelos College of Physicians and Surgeons, USA.
RTI International, USA.
Int J Cardiol Cardiovasc Risk Prev. 2021 Aug 12;10:200105. doi: 10.1016/j.ijcrp.2021.200105. eCollection 2021 Sep.
Reduced uterine artery compliance is associated with adverse pregnancy outcomes (APOs) and may indicate underlying maternal cardiovascular pathology. We investigated associations between second trimester uterine artery Doppler (UAD) parameters and incident maternal hypertension 2-7 years after delivery.
A cohort of 10,038 nulliparous US participants was recruited early in pregnancy. A subgroup of 3739, without baseline hypertension and with complete follow-up visits 2-7 years after delivery, were included in this analysis. We investigated UAD indicators of compliance including: 1) early diastolic notch; 2) resistance index (RI); and 3) pulsatility index (PI). We defined hypertension as systolic blood pressure ≥130 mmHg, diastolic ≥80 mmHg, or antihypertensive medication use. We calculated odds ratios (OR) and 95 % confidence intervals (95%CI) for associations between UAD parameters and hypertension, adjusting for age, obesity, race/ethnicity, insurance, smoking, and APOs.
A total of 187 (5 %) participants developed hypertension after the index pregnancy. Presence of early diastolic notch on UAD was not associated with incident hypertension. Increased RI and PI correlated with higher odds of hypertension (RI: adjusted OR 1.15 [95 % CI 1.03-1.30]; PI: adjusted OR 1.03 [95%CI 1.01-1.05] for each 0.1 unit increase). Maximum RI above 0.84 or maximum PI above 2.3 more than doubled the odds of incident hypertension (RI: adjusted OR 2.49, 95%CI 1.45-4.26; PI: adjusted OR 2.36, 95%CI 1.45-3.86).
Higher resistance and pulsatility indices measured on second trimester UAD were associated with increased odds of incident hypertension 2-7 years later, and may be biomarkers of higher maternal cardiovascular risk.
子宫动脉顺应性降低与不良妊娠结局（APO）相关，可能提示潜在的母体心血管病变。我们研究了孕中期子宫动脉多普勒（UAD）参数与产后2至7年发生的母体高血压之间的关联。
招募了10,038名美国初产妇队列，在妊娠早期入组。本分析纳入了3739名亚组，这些参与者无基线高血压且产后2至7年有完整的随访。我们研究了UAD顺应性指标，包括：1）舒张早期切迹；2）阻力指数（RI）；3）搏动指数（PI）。我们将高血压定义为收缩压≥130 mmHg、舒张压≥80 mmHg或使用抗高血压药物。我们计算了UAD参数与高血压之间关联的比值比（OR）和95%置信区间（95%CI），并对年龄、肥胖、种族/民族、保险、吸烟和APO进行了校正。
共有187名（5%）参与者在本次妊娠后发生高血压。UAD上舒张早期切迹的存在与高血压的发生无关。RI和PI升高与高血压几率增加相关（RI：每增加0.1单位，校正OR为1.15 [95%CI 1.03 - 1.30]；PI：校正OR为1.03 [95%CI 1.01 - 1.05]）。最大RI高于0.84或最大PI高于2.3使高血压发生几率增加一倍以上（RI：校正OR为2.49，95%CI 1.45 - 4.26；PI：校正OR为2.36，95%CI 1.45 - 3.86）。
孕中期UAD测量的较高阻力指数和搏动指数与2至7年后高血压发生几率增加相关，可能是母体心血管风险较高的生物标志物。
