Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Grossman School of Medicine, New York University, New York City, New York, USA.
Paediatr Perinat Epidemiol. 2024 Mar;38(3):204-215. doi: 10.1111/ppe.13055. Epub 2024 Feb 20.
Reported rates of maternal mortality in the United States have been staggeringly high and increasing, and cardiovascular disease (CVD) is a chief contributor to such deaths. However, the impact of hypertensive disorders of pregnancy (HDP) on the short-term risk of cardiovascular death is not well understood.
To evaluate the association between HDP (chronic hypertension, gestational hypertension, preeclampsia, eclampsia, and superimposed preeclampsia) and pregnancy-associated mortality rates (PMR) from all causes, CVD-related causes both at delivery and within 1 year following delivery.
We used the Nationwide Readmissions Database (2010-2018) to examine PMRs for females 15-54 years old. International Classification of Disease 9 and 10 diagnosis codes were used to identify pregnancy-associated deaths due to HDP and CVD. Discrete-time Cox proportional hazards regression models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for mortality at delivery (0 days) and at <30, <60, <90, <180, and <365 days after delivery in relation to HDP.
Of 33,417,736 hospital deliveries, the rate of HDP was 11.0% (n = 3,688,967), and the PMR from CVD was 6.4 per 100,000 delivery hospitalisations (n = 2141). Compared with normotensive patients, HRs for CVD-related PMRs increased with HDP severity, reaching over 58-fold for eclampsia patients. HRs were higher for stroke-related (1.2 to 170.9) than heart disease (HD)-related (0.99 to 39.8) mortality across all HDPs. Except for gestational hypertension, the increased risks of CVD mortality were evident at delivery and persisted 1 year postpartum for all HDPs.
HDPs are strong risk factors for pregnancy-associated mortality due to CVD at delivery and within 1 year postpartum; the risks are stronger for stroke than HD-related PMR. While absolute PMRs are low, this study supports the importance of extending postpartum care beyond the traditional 42-day postpartum visit for people whose pregnancies are complicated by hypertension.
美国报告的孕产妇死亡率高得惊人且呈上升趋势，心血管疾病（CVD）是导致此类死亡的主要原因。然而，妊娠高血压疾病（HDP）对短期心血管死亡风险的影响尚不清楚。
评估 HDP（慢性高血压、妊娠期高血压、子痫前期、子痫和子痫前期合并症）与所有原因、分娩时和分娩后 1 年内与 CVD 相关的原因导致的妊娠相关死亡率（PMR）之间的关联。
我们使用全国再入院数据库（2010-2018 年）检查了 15-54 岁女性的 PMR。国际疾病分类第 9 版和第 10 版诊断代码用于确定 HDP 和 CVD 导致的妊娠相关死亡。离散时间 Cox 比例风险回归模型用于计算与 HDP 相关的分娩时（0 天）和分娩后<30、<60、<90、<180 和<365 天死亡率的调整后危险比（HR）和 95%置信区间（CI）。
在 33417736 例分娩中，HDP 的发生率为 11.0%（n=3688967），CVD 导致的 PMR 为每 100000 例分娩住院治疗 6.4 例（n=2141）。与正常血压患者相比，随着 HDP 严重程度的增加，与 CVD 相关的 PMR 的 HR 增加，子痫前期患者的 HR 超过 58 倍。与心脏病（HD）相关（0.99 至 39.8）死亡率相比，所有 HDP 患者的中风相关死亡率（1.2 至 170.9）更高。除了妊娠期高血压，所有 HDP 的 CVD 死亡风险在分娩时增加，并在分娩后 1 年持续存在。
HDP 是分娩时和分娩后 1 年内与 CVD 相关的妊娠相关死亡的强烈危险因素；与 HD 相关的 PMR 相比，中风的风险更高。虽然绝对 PMR 较低，但这项研究支持为因高血压而妊娠复杂化的人群延长产后护理时间超过传统的 42 天产后访视的重要性。
