Li Yongle, Hu Jiteng, Duan Jiao, Wen Junjian, Huang Jianxiong, Shen Jie, Hu Zurong, Qin Zaisheng
Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Department of Anesthesiology, Guangzhou United Family Hospital, Guangzhou, Guangdong, China.
PLoS One. 2025 Aug 18;20(8):e0325476. doi: 10.1371/journal.pone.0325476. eCollection 2025.
This study aimed to investigate the association of different durations of labor epidural analgesia (LEA) on early-onset postpartum hypertension (PPHTN) among parturients with hypertensive disorders of pregnancy (HDP).
We conducted a retrospective cohort study in which patients who were diagnosed with hypertensive disorders of pregnancy between 2018 and 2023. The parturients who received LEA were divided into three groups based on the tertiles of LEA duration: the short-duration group (< 175 minutes), the medium-duration group (175-324 minutes), and the long-duration group (≥ 325 minutes), while parturients who did not receive LEA forming the control group. The primary outcome was early-onset PPTHN, defined as the occurrence of at least one blood pressure measurement meeting hypertensive criteria within 2 days following delivery. Three multivariate logistic regression models was employed to explore the association between the duration of LEA exposure and early-onset PPHTN. Four sets of sensitivity analyses were conducted to assess the robustness of the analysis.
In the study cohort of 1,316 parturients, 36.0% (n = 474) were diagnosed with early-onset PPHTN. Compared with those who did not receive LEA, parturients who received long-exposure LEA had significantly lower incidences of early-onset PPHTN (29.5% vs 41.7%, P < 0.05). Univariate survival analysis demonstrated that long-duration LEA was associated with a lower risk of PPHTN during hospitalization (HR = 0.75, 95% CI: 0.59-0.95, P < 0.05). All three models showed long-exposure LEA exposure was associated with a reduced incidence of early-onset PPHTN among parturients with HDP. Consistent results were observed in the sensitivity analysis conducted among parturients with documented antepartum hypertension who received multiple antihypertensive medications during pregnancy, as well as among those who did not require antihypertensive therapy during the postpartum period. However, this association did not reach statistical significance when the follow-up period was extended to five days postpartum, or in subgroups of parturients with advanced maternal age, obesity, or PE.
A longer duration of LEA was associated with a reduced risk of early-onset PPHTN among women with HDP. However, this association did not reach statistical significance in subgroups of parturients with advanced maternal age, obesity, or PE.
本研究旨在探讨分娩期硬膜外镇痛（LEA）不同时长与妊娠高血压疾病（HDP）产妇早发型产后高血压（PPHTN）之间的关联。
我们进行了一项回顾性队列研究，纳入2018年至2023年间被诊断为妊娠高血压疾病的患者。接受LEA的产妇根据LEA时长的三分位数分为三组：短时长组（<175分钟）、中时长组（175 - 324分钟）和长时长组（≥325分钟），未接受LEA的产妇作为对照组。主要结局是早发型PPTHN，定义为分娩后2天内至少有一次血压测量符合高血压标准。采用三个多因素逻辑回归模型探讨LEA暴露时长与早发型PPHTN之间的关联。进行了四组敏感性分析以评估分析的稳健性。
在1316名产妇的研究队列中，36.0%（n = 474）被诊断为早发型PPHTN。与未接受LEA的产妇相比，接受长时长LEA的产妇早发型PPHTN的发生率显著更低（29.5%对41.7%，P < 0.05）。单因素生存分析表明，长时长LEA与住院期间PPHTN风险较低相关（HR = 0.75，95%CI：0.59 - 0.95，P < 0.05）。所有三个模型均显示，长时长LEA暴露与HDP产妇早发型PPHTN发生率降低相关。在有记录的产前高血压且孕期接受多种降压药物治疗的产妇以及产后不需要降压治疗的产妇中进行的敏感性分析中观察到了一致的结果。然而，当随访期延长至产后五天时，或者在高龄产妇、肥胖产妇或患有子痫前期的产妇亚组中，这种关联未达到统计学意义。
较长时长的LEA与HDP女性早发型PPHTN风险降低相关。然而，在高龄产妇、肥胖产妇或患有子痫前期的产妇亚组中，这种关联未达到统计学意义。
