Eur J Preven Cardio:高血压、肥胖等孕前心血管危险因素不可忽视!胎儿死亡风险可增高至8.7倍

2021-07-27 网络 网络

不良妊娠(怀孕)事件,比如早产、先兆子痫(一种妊娠期高血压)、胎儿子宫内生长受限等,与妇女及孩子日后长期心血管疾病风险的增加相关。

不良妊娠(怀孕)事件,比如早产、先兆子痫(一种妊娠期高血压)、胎儿子宫内生长受限等,与妇女及孩子日后长期血管疾病风险的增加相关。

而女性在怀孕之前,自身的心血管危险因素,比如高血压、肥胖等,又会增加孕产期间不良妊娠事件的发生风险。

这样看来,为了避免孕期并发症,降低个人及孩子未来心血管疾病的发病风险,女性在孕前控制好个人体重与血压等,就显得尤为重要。当然,这也需要家人的帮助和支持。

不过,当下形势并不乐观,无论国内外,育龄妇女的心血管危险因素合并率正不断攀升,有必要确定妇女孕前心血管风险因素的总负担与不良妊娠事件之间的关联。

为此,美国西北大学医学院学者发表在欧洲预防心脏病学杂志《European Journal of Preventive Cardiology》上的最新文章,对美国国家卫生统计中心(NCHS)的孕产妇和胎儿数据进行了横断面分析。

研究人员最终纳入近1900万次孕产数据,产妇平均年龄为28.6岁。

研究确定了四项孕前心血管危险因素,包括:异常体重指数(BMI<18.5?kg/m2或>24.9?kg/m2),吸烟,高血压、糖尿病。有任意一项危险因素即为1分,逐个叠加,最低0分,最高4分。存在1、2、3 和 4 个危险因素的孕产妇比例分别为52.5%、7.3%、0.3% 和 0.02%。

相比无上述四项危险因素的女性,有一个或多个危险因素的女性,平均受教育程度较低,接受产前护理率较低,多产比例较高,既往流产史比例较高。

该研究关注的不良妊娠事件包括:孕产妇ICU入院,早产,低出生体重,胎儿死亡。

图1. 合并不同数量孕前心血管危险因素,孕产妇和子代不良事件的相对风险

分析结果显示,孕前合并的危险因素越多,不良妊娠事件的发生风险越高,存在分级关联。比如,与无上述四项心血管危险因素的孕产妇相比,当孕产妇存在1-4项危险因素时,入住ICU的风险分别增加至1.12倍、1.86倍、4.24倍和5.79倍。

当孕前同时存在异常体重指数、吸烟、高血压和糖尿病四项心血管危险因素时,早产风险增高至3.9倍,低体重出生风险增高至2.8倍,胎儿死亡风险增高至8.7倍。

表1. 合并各项孕前心血管危险因素,孕产妇和子代不良事件的相对风险

另外,各心血管危险因素均与各不良妊娠事件直接相关,除了孕前异常BMI,低出生体重风险不但不会增加,反而会降低。想想也不难理解,美国的异常BMI人群,大多为超重肥胖人群,这里或许也应关注下成年后心脏病风险偏高的高出生体重儿。

该项全美研究,一方面发现了女性孕前心血管危险因素的普遍存在性,另一方面确认了不同程度心血管危险因素负担与孕产妇不良妊娠事件的分级关联。

未来,还应关注更多孕期心血管危险因素的影响,比如胆固醇水平,以及运动、睡眠、膳食等生活方式因素。

原始出处:

Michael C Wang, et al. Association of pre-pregnancy cardiovascular risk factor burden with adverse maternal and offspring outcomes. European Journal of Preventive Cardiology. Published: 20 July 2021.

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    2021-11-08 小雨闲

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    2021-08-25 szhvet
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    2021-07-28 liuxiaona
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