Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Am J Clin Nutr. 2022 Sep 2;116(3):750-758. doi: 10.1093/ajcn/nqac145.
Many studies have linked intakes of fat and of specific fatty acids during pregnancy with preeclampsia; however, information on the association of intake before pregnancy with hypertensive disorders of pregnancy (HDP) is scant.
We evaluated the associations of intakes of major and specific types of fat before pregnancy with the risks of HDP, including preeclampsia and gestational hypertension (GHTN).
We followed 11,535 women without chronic disease participating in the Nurses' Health Study II from 1991 and 2009. Pre-pregnancy dietary fat was assessed by an FFQ. Intakes of total fat, saturated fat, trans fatty acid (TFA), MUFAs, PUFAs, and fat subtypes (omega-3 and omega-6) were categorized into quintiles of intake. HDP were self-reported. The RRs (95% CIs) of HDP were estimated by log-binomial generalized estimating equation regression models, with an exchangeable correlation matrix to account for repeated pregnancies while adjusting for potential confounders.
During 19 years of follow-up, there were 495 cases of preeclampsia (2.9%) and 561 (3.3%) cases of GHTN in 16,892 singleton pregnancies. The mean age at pregnancy was 34.6 years (SD, 3.9 years). Among major fat types, only pre-pregnancy TFA was related to a higher risk of HDP (RR, 1.32; 95% CI: 1.05-1.66), and only for preeclampsia (RR, 1.50; 95% CI: 1.07-2.10) but not for GHTN (RR, 1.21; 95% CI: 0.87-1.70). Among specific types of PUFAs, intake of arachidonic acid was positively related with GHTN (RR, 1.43; 95% CI: 1.00-2.04) but not preeclampsia (RR, 1.08; 95% CI: 0.75-1.57). In analyses restricted to pregnancies 1 year after the diet assessment, women with the highest intake of long-chain omega-3 fatty acids had a 31% lower risk of HDP (95% CI: 3%-51%), which was driven by preeclampsia (RR, 0.55; 95% CI: 0.33-0.92).
Pre-pregnancy intakes of total fat, saturated fat, and MUFA were unrelated to HDP, whereas TFA was positively related to HDP. These findings highlight the importance of ongoing efforts to eliminate TFA from the global food supply.
许多研究表明，孕妇脂肪和特定脂肪酸的摄入量与子痫前期有关；然而，关于孕前摄入与妊娠高血压疾病（HDP）之间关联的信息却很少。
我们评估了孕前主要和特定类型脂肪的摄入量与 HDP（包括子痫前期和妊娠期高血压）风险之间的关系。
我们随访了 1991 年至 2009 年期间参加护士健康研究 II 的 11535 名无慢性病的女性。通过 FFQ 评估孕前饮食中的脂肪。总脂肪、饱和脂肪、反式脂肪酸（TFA）、单不饱和脂肪酸（MUFAs）、多不饱和脂肪酸（PUFAs）和脂肪亚型（omega-3 和 omega-6）的摄入量分为五分位数。HDP 通过自我报告确定。使用对数二项广义估计方程回归模型估计 HDP 的 RR（95%CI），采用可交换相关矩阵来解释重复妊娠，同时调整潜在混杂因素。
在 19 年的随访期间，在 16892 次单胎妊娠中，有 495 例子痫前期（2.9%）和 561 例妊娠期高血压（3.3%）。妊娠时的平均年龄为 34.6 岁（标准差，3.9 岁）。在主要脂肪类型中，只有孕前 TFA 与 HDP 风险增加相关（RR，1.32；95%CI：1.05-1.66），并且仅与子痫前期相关（RR，1.50；95%CI：1.07-2.10），而与妊娠期高血压无关（RR，1.21；95%CI：0.87-1.70）。在特定类型的多不饱和脂肪酸中，花生四烯酸的摄入量与妊娠期高血压呈正相关（RR，1.43；95%CI：1.00-2.04），但与子痫前期无关（RR，1.08；95%CI：0.75-1.57）。在限制为饮食评估后 1 年内妊娠的分析中，长链 omega-3 脂肪酸摄入量最高的女性 HDP 风险降低了 31%（95%CI：3%-51%），这主要归因于子痫前期（RR，0.55；95%CI：0.33-0.92）。
孕前总脂肪、饱和脂肪和 MUFA 的摄入量与 HDP 无关，而 TFA 与 HDP 呈正相关。这些发现强调了从全球食物供应中消除 TFA 的持续努力的重要性。
