双胎妊娠和单胎妊娠合并妊娠期高血压疾病后十年的心血管死亡风险
Cardiovascular mortality risk a decade after twin and singleton pregnancies complicated by hypertensive disorders of pregnancy.
作者信息
van Baar Petra M, Welters Sophie M, Ravelli Anita C J, de Boer Marjon A, de Groot Christianne J M
机构信息
Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1117, 1018 HV Amsterdam, the Netherlands.
Department of Obstetrics and Gynecology, Reproduction and Development, Amsterdam UMC, Location VU University Medical Center, De Boelelaan 1117, 1018 HV Amsterdam, the Netherlands.
出版信息
Pregnancy Hypertens. 2022 Jun;28:9-14. doi: 10.1016/j.preghy.2022.01.009. Epub 2022 Feb 2.
OBJECTIVES
To describe the cardiovascular mortality (CVM) risk in women after twin versus singleton pregnancies complicated by hypertensive disorders of pregnancy (HDP).
STUDY DESIGN
Retrospective cohort study of nulliparous women with a twin or singleton pregnancy who delivered in the Netherlands between 1995 and 2015. We used data of the Perinatal Registry of the Netherlands and data of the National Death Registry to determine baseline data, the occurrence of HDP and CVM. In the two main analyses we compared twin pregnancies complicated by HDP to 1) singleton pregnancies complicated by HDP and 2) uncomplicated twin pregnancies (i.e. without HDP) of women who delivered within a hospital setting.
MAIN OUTCOME MEASURES
CVM risk using cox-proportional hazard models, adjusted for maternal age (aHR).
RESULTS
1,243,231 nulliparous women were included, of which 30,623 (2.5%) had a twin and 1,212,608 (97.5%) had a singleton pregnancy. A total of 9,853 (32.2%) twin pregnancies were complicated by HDP, versus 249,141 (20.6%) singleton pregnancies (p < 0.0001). Within the HDP twin cohort, 14/73 (19.2%) maternal deaths were due to cardiovascular causes, versus 335/1,788 (18.7%) in the HDP singleton cohort and 10/117 (8.6%) in the uncomplicated twin cohort. The corresponding aHR was 2.85 (95% CI 1.26-6.41; p = 0.01) for the HDP twin versus the uncomplicated twin cohort, and 1.05 (95% CI 0.62-1.80; p = 0.85) for the HDP twin versus the HDP singleton cohort.
CONCLUSIONS
Women after both twin and singleton pregnancies complicated by HDP are at a similarly increased risk of CVM later in life.
目的
描述双胎妊娠与单胎妊娠合并妊娠期高血压疾病（HDP）后女性的心血管疾病死亡率（CVM）风险。
研究设计
对1995年至2015年在荷兰分娩的未生育双胎或单胎妊娠女性进行回顾性队列研究。我们使用荷兰围产期登记数据和国家死亡登记数据来确定基线数据、HDP的发生情况和CVM。在两项主要分析中，我们将合并HDP的双胎妊娠与1）合并HDP的单胎妊娠以及2）在医院分娩的未合并HDP的双胎妊娠（即无HDP）进行比较。
主要观察指标
使用Cox比例风险模型调整产妇年龄后的CVM风险（aHR）。
结果
纳入1,243,231例未生育女性，其中30,623例（2.5%）为双胎妊娠，1,212,608例（97.5%）为单胎妊娠。共有9,853例（32.2%）双胎妊娠合并HDP，而单胎妊娠合并HDP的有249,141例（20.6%）（p < 0.0001）。在合并HDP的双胎队列中，14/73例（19.2%）孕产妇死亡归因于心血管原因，合并HDP的单胎队列中为335/1,788例（18.7%），未合并HDP的双胎队列中为10/117例（8.6%）。合并HDP的双胎与未合并HDP的双胎队列相比，相应的aHR为2.85（95%CI 1.26 - 6.41；p = 0.01），合并HDP的双胎与合并HDP的单胎队列相比，aHR为1.05（95%CI 0.62 - 1.80；p = 0.85）。
结论
双胎妊娠和单胎妊娠合并HDP后的女性在生命后期发生CVM的风险同样增加。
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