Department of Obstetrics and Gynecology, the Department of Pediatrics, and the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, and the Health Economics Resource Center, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California; the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and the Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota.
Obstet Gynecol. 2023 Oct 1;142(4):862-871. doi: 10.1097/AOG.0000000000005342. Epub 2023 Sep 7.
To evaluate whether there are individual- and population-level associations between chronic hypertension and pregnancy complications, and to assess differences across seven racial-ethnic groups.
This population-based study used linked vital statistics and hospitalization discharge data from all live and stillbirths in California (2008-2018), Michigan (2008-2020), Oregon (2008-2020), Pennsylvania (2008-2014), and South Carolina (2008-2020). We used multivariable log-binomial regression models to estimate risk ratios (RRs) and population attributable risk (PAR) percentages with 95% CIs for associations between chronic hypertension and several obstetric and neonatal outcomes, selected based on prior evidence and pathologic pathways. We adjusted models for demographic factors (race and ethnicity, payment method, educational attainment), age, body mass index, obstetric history, delivery year, and state, and conducted analyses stratified across seven racial-ethnic groups.
The study included 7,955,713 pregnancies, of which 168,972 (2.1%) were complicated by chronic hypertension. Chronic hypertension was associated with several adverse obstetric and neonatal outcomes, with the largest adjusted PAR percentages observed for preeclampsia with severe features or eclampsia (22.4; 95% CI 22.2-22.6), acute renal failure (13.6; 95% CI 12.6-14.6), and pulmonary edema (10.7; 95% CI 8.9-12.6). Estimated RRs overall were similar across racial-ethnic groups, but PAR percentages varied. The adjusted PAR percentages (95% CI) for severe maternal morbidity-a widely used composite of acute severe events-for people who were American Indian or Alaska Native, Asian, Black, Latino, Native Hawaiian or Other Pacific Islander, White, and Multiracial or Other were 5.0 (1.1-8.8), 3.7 (3.0-4.3), 9.0 (8.2-9.8), 3.9 (3.6-4.3), 11.6 (6.4-16.5), 3.2 (2.9-3.5), and 5.5 (4.2-6.9), respectively.
Chronic hypertension accounts for a substantial fraction of obstetric and neonatal morbidity and contributes to higher complication rates, particularly for people who are Black or Native Hawaiian or Other Pacific Islander.
评估慢性高血压与妊娠并发症在个体和人群层面上的关联，并评估七个种族群体之间的差异。
这项基于人群的研究使用了加利福尼亚州（2008-2018 年）、密歇根州（2008-2020 年）、俄勒冈州（2008-2020 年）、宾夕法尼亚州（2008-2014 年）和南卡罗来纳州（2008-2020 年）所有活产儿和死产儿的链接生命统计和住院出院数据。我们使用多变量对数二项式回归模型，根据先前的证据和病理途径，估计慢性高血压与几种产科和新生儿结局之间的风险比（RR）和人群归因风险（PAR）百分比，并计算 95%置信区间。我们调整了模型以适应人口统计学因素（种族和民族、支付方式、教育程度）、年龄、体重指数、产科史、分娩年份和州，并按七个种族群体进行分层分析。
这项研究共纳入了 7955713 例妊娠，其中 168972 例（2.1%）合并慢性高血压。慢性高血压与多种不良产科和新生儿结局相关，调整后的最大 PAR 百分比见于重度子痫前期或子痫（22.4%；95%CI 22.2-22.6）、急性肾衰竭（13.6%；95%CI 12.6-14.6）和肺水肿（10.7%；95%CI 8.9-12.6）。总体而言，RR 估计值在不同种族群体之间相似，但 PAR 百分比有所不同。美国印第安人或阿拉斯加原住民、亚裔、黑人、拉丁裔、夏威夷原住民或其他太平洋岛民、白人以及多种族或其他种族人群的严重产妇发病率（一种广泛使用的急性严重事件综合指标）的调整后 PAR 百分比（95%CI）分别为 5.0（1.1-8.8）、3.7（3.0-4.3）、9.0（8.2-9.8）、3.9（3.6-4.3）、11.6（6.4-16.5）、3.2（2.9-3.5）和 5.5（4.2-6.9）。
慢性高血压占产科和新生儿发病率的很大一部分，并导致更高的并发症发生率，特别是对于黑人或夏威夷原住民或其他太平洋岛民。
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