Li Xiaolan, Kang Fen, Li Xiaojing, Du Xue, Yang Yuanyuan
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, 230022, Anhui, China.
NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract (Anhui Medical University), Hefei, 230032, Anhui, China.
Reprod Sci. 2025 Jan;32(1):139-149. doi: 10.1007/s43032-024-01674-w. Epub 2024 Aug 12.
This study aimed to explore the different characteristics between early-onset severe preeclampsia (ESPE) and late-onset severe preeclampsia (LSPE) to improve pregnancy outcomes. We performed a retrospective cohort study between January 2016 and December 2021. Eligible hospitalized pregnant women with severe preeclampsia were assigned into the early-onset or late-onset group, depending on the gestational age at the time of severe preeclampsia onset (< or ≥ 34 gestational weeks, respectively). The clinical characteristics, laboratory results, maternal complications, and fetal and neonatal outcomes were recorded and compared between the two groups. A total of 1,238 pregnant women were included, with 525 in the early-onset group and 713 in the late-onset group. The late-onset group had more cases of gestational diabetes, whereas the early-onset group had a higher blood pressure, showed more proteinuria, had more liver and renal damage, exhibited more serious adverse maternal, fetal, and neonatal outcomes, was more likely to be admitted to the intensive care unit, and required longer hospital stays (all P < 0.05). In addition, the early-onset group had fewer prenatal care appointments and was more often transferred from a primary or secondary care hospital. The logistic regression analysis showed that a weekly weight gain of > 100 g was a risk factor for ESPE and that fewer prenatal care appointments were a risk factor for ESPE in pregnant women with female fetuses. Moreover, logistic regression analysis indicated that nulliparity and gestational diabetes during the current pregnancy were risk factors for LSPE. In conclusion, compared with the women with LSPE, those with ESPE usually had worse maternal, fetal, and neonatal outcomes. More frequent prenatal screening and care should be provided for pregnant women with high-risk factors.
本研究旨在探讨早发型重度子痫前期（ESPE）和晚发型重度子痫前期（LSPE）之间的不同特征，以改善妊娠结局。我们在2016年1月至2021年12月期间进行了一项回顾性队列研究。符合条件的重度子痫前期住院孕妇根据重度子痫前期发病时的孕周（分别为<或≥34孕周）被分为早发型或晚发型组。记录并比较两组的临床特征、实验室检查结果、孕产妇并发症以及胎儿和新生儿结局。共纳入1238名孕妇，早发型组525例，晚发型组713例。晚发型组妊娠期糖尿病病例更多，而早发型组血压更高、蛋白尿更多、肝肾功能损害更多、孕产妇、胎儿和新生儿不良结局更严重、更有可能入住重症监护病房且住院时间更长（所有P<0.05）。此外，早发型组产前检查次数较少，且更多是从基层或二级医院转诊而来。逻辑回归分析显示，每周体重增加>100 g是ESPE的一个危险因素，而产前检查次数较少是女性胎儿孕妇发生ESPE的一个危险因素。此外，逻辑回归分析表明，初产和本次妊娠期间的妊娠期糖尿病是LSPE的危险因素。总之，与LSPE患者相比，ESPE患者的孕产妇、胎儿和新生儿结局通常更差。应对有高危因素的孕妇提供更频繁的产前筛查和护理。
