美国纽约州西奈山伊坎医学院Casey Crump团队研究了不良妊娠结局与母亲缺血性心脏病的长期风险。2023年2月1日出版的《英国医学杂志》发表了这项成果。

为了探讨五种主要不良妊娠结局与母亲患缺血性心脏病的长期风险之间的关系，研究组在瑞典进行了一项国家队列研究，招募1973-2015年在瑞典首次单胎分娩的2195266名女性。主要结局指标是从全国住院和门诊诊断中确定的分娩至2018年缺血性心脏病的发病率。

Cox回归用于计算与早产、小于胎龄儿、先兆子痫、其他妊娠高血压疾病和妊娠期糖尿病相关的缺血性心脏病的风险比，并对其他不良妊娠结局和母体因素进行校正。通过共同的家族（遗传和环境）因素评估同胞分析的混杂。

在5360万人-年的随访中，83881名（3.8%）女性被诊断为缺血性心脏病 。所有五种不良妊娠结局均与缺血性心脏病风险增加独立相关。在分娩后的10年内，与特定不良妊娠结局相关的缺血性心脏病的校正危险比，其他妊娠高血压疾病为2.09，早产为1.72，先兆子痫为1.54，妊娠期糖尿病为1.30，小于胎龄儿为1.10。

即使在分娩后30-46年，危险比仍显著增加：其他妊娠高血压疾病为1.47，妊娠期糖尿病为1.40，先兆子痫为1.32，早产为1.23，小于胎龄儿为1.16。这些发现仅部分（<45%）由共同的家族（遗传或环境）因素解释。经历多次不良妊娠结局的女性风险进一步增加（例如，分娩后<10年，与1、2或≥3次不良妊娠结局相关的校正风险比分别为1.29、1.80和2.26）。

综上，在这一大型国家队列中，经历五种主要不良妊娠结局的女性在分娩后46年内患缺血性心脏病的风险增加。应考虑对妊娠结局不良的妇女进行早期预防性评估和长期降低风险，以帮助预防缺血性心脏病的发展。

附：英文原文

Title: Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study

Author: Casey Crump, Jan Sundquist, Mary Ann McLaughlin, Siobhan M Dolan, Usha Govindarajulu, Weiva Sieh, Kristina Sundquist

Issue&Volume: 2023/02/01

Abstract:

Objective To examine the associations between five major adverse pregnancy outcomes and long term risks of ischemic heart disease in mothers.

Design National cohort study.

Setting Sweden.

Participants All 2195266 women with a first singleton delivery in Sweden during 1973-2015.

Main outcome measures The main outcome measure was incidence of ischemic heart disease from delivery to 2018, identified from nationwide inpatient and outpatient diagnoses. Cox regression was used to calculate hazard ratios for ischemic heart disease associated with preterm delivery, small for gestational age, pre-eclampsia, other hypertensive disorders of pregnancy, and gestational diabetes, adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic and environmental) factors.

Results During 53.6 million person years of follow-up, ischemic heart disease was diagnosed in 83881 (3.8%) women. All five adverse pregnancy outcomes were independently associated with increased risk of ischemic heart disease. In the 10 years after delivery, adjusted hazard ratios for ischemic heart disease associated with specific adverse pregnancy outcomes were 2.09 (95% confidence interval 1.77 to 2.46) for other hypertensive disorders of pregnancy, 1.72 (1.55 to 1.90) for preterm delivery, 1.54 (1.37 to 1.72) for pre-eclampsia, 1.30 (1.09 to 1.56) for gestational diabetes, and 1.10 (1.00 to 1.21) for small for gestational age. The hazard ratios remained significantly increased even 30-46 years after delivery: 1.47 (1.30 to 1.66) for other hypertensive disorders of pregnancy, 1.40 (1.29 to 1.51) for gestational diabetes, 1.32 (1.28 to 1.36) for pre-eclampsia, 1.23 (1.19 to 1.27) for preterm delivery, and 1.16 (1.13 to 1.19) for small for gestational age. These findings were only partially (<45%) explained by shared familial (genetic or environmental) factors. Women who experienced multiple adverse pregnancy outcomes showed further increases in risk (eg, <10 years after delivery, adjusted hazard ratios associated with 1, 2, or ≥3 adverse pregnancy outcomes were 1.29 (1.19 to 1.39), 1.80 (1.59 to 2.03), and 2.26 (1.89 to 2.70), respectively)).

Conclusions In this large national cohort, women who experienced any of five major adverse pregnancy outcomes showed an increased risk for ischemic heart disease up to 46 years after delivery. Women with adverse pregnancy outcomes should be considered for early preventive evaluation and long term risk reduction to help prevent the development of ischemic heart disease.

DOI: 10.1136/bmj-2022-072112

Source: https://www.bmj.com/content/380/bmj-2022-072112