HDP患病率、风险因素及其与不良妊娠结局的关系研究

The prevalence, risk factors of HDP and its association with adverse pregnancy outcomes

关键词:  妊娠高血压疾病  母婴妊娠结局  危险因素

Key words:  hypertensive disorders of pregnancy  maternal and perinatal outcomes  risk factors

摘要:

目的 调查妊娠高血压疾病(hypertensive disorders of pregnancy, HDP)的患病率,及危险因素,探究HDP与不良妊娠结局的关系。方法采用回顾性调查法,选取2010年1月至12月期间在上海第一妇婴保健院、第十人民医院住院分娩的所有孕产妇作为研究对象。以Logistic回归分析评估HDP相关危险因素,探索HDP与分娩方式、母婴不良结局之间的关系。结果 7347例孕产妇中,有182例发生HDP,患病率为2.48%。多因素Logistic回归分析显示,分娩年龄＞35岁、超重/肥胖、基础收缩压＞120mmHg、基础舒张压＞80mmHg、高血压家族史、多胎、初产、合并心脏病是HDP的危险因素,而产检次数＞8则是HDP的保护性因素。以自然分娩为参照,HDP组剖宫产率高于对照组(OR=10.09,5%CI:5.61~18.16),产钳助产率则无统计学差异(P＞0.05)。两组母婴不良结局比较:以出生体重正常组为参照,HDP组婴儿出生体重＜2500g的发生率高于对照组(OR=7.44,5%CI:5.15～10.75);以分娩孕周正常组为参照,HDP组分娩孕周＜37周的发生率高于对照组(OR=4.99,95%CI:3.56～7.02)；HDP组新生儿1min Apgar评分＜7(OR=3.14,5%CI:1.25～7.91)、黄疸(OR=26.53,5%CI:4.41～159.72)、新生儿转儿科或转院(OR=3.94,5%CI:2.31～6.73)、胎儿宫内生长迟缓(OR=8.45,5%CI:2.85～25.09)、胎盘早剥(OR=5.30,5%CI:1.20～23.33)、产后出血发生率均高于对照组(OR=1.27,5%CI:1.27～8.01),而5min Apgar评分＜7、围产儿死亡发生率则无统计学差异(P＞0.05)。结论妊娠高血压疾病的发生是多种因素作用的结果,它与分娩年龄、超重/肥胖、基础血压等因素密切相关。因此,建议孕妇饮食营养均衡、控制体重,定期进行产前检查、监测血压变化,以降低HDP患病率,减少母婴不良结局的发生。

Abstract:

Objective To evaluate the prevalence and risk factors of hypertensive disorders of pregnancy (HDP), to explore its association with adverse pregnancy outcomes. Methods We performed a retrospective study of all the pregnancies delivered in Shanghai First Maternity and Infant Health Institute and the Tenth People's Hospital from January to December 2010. Multiple logistic regression was applied to evaluate risk factors of HDP, and its relationship with mode of delivery and adverse maternal and perinatal outcomes. Results A total of 7347 pregnant women were investigated, among which 182 suffered from HDP with a prevalence rate of 2.48%. Risk factors were identified with multiple logistic regression, including maternity age＞35, overweight/obesity, basic systolic blood pressure ＞120mmHg, basic diastolic blood pressure＞80mmHg, family history of hypertension, multiparity, primiparous and complicated heart disease. While number of antenatal care visits＞8 was a protective factor for HDP. Spontaneous delivery as a reference, The rate of cesarean in HDP group increased (OR=10.09,5%CI:5.61-18.16),while there was no significant increase in induced delivery rate (P＞0.05). Normal birth weight as a reference, the rate of birth weight＜2500g in HDP group was increased than control group (OR=7.44,5%CI:5.15-10.75). The rate of 1min Apgar score＜7, jaundice, transfer or referral to pediatric department, intrauterine growth retardation, premature abruption, postpartum hemorrhage were increased among pregnant women with HDP, the ORs(95%CI) were 3.14 (1.25-7.91), 26.53 (4.41-159.72), 3.94 (2.31-6.73), 8.45(2.85-25.09), 5.30 (1.20-23.33) and 1.27(1.27-8.01), respectively. No significant difference was found between two groups in the rate of 5min Apgar score＜7 and perinatal death (P＞0.05). Conclusion Advanced maternal age, overweight/obesity, higher basic blood pressure and other factors can increase the risk of HDP, corresponding measures (balanced diet, weight control, regular prenatal care visit and blood pressure monitor) should be taken to decrease the prevalence of HDP and reduce adverse maternal and perinatal outcomes.