复旦大学余勇夫教授团队研究了母亲妊娠期高血压疾病与后代从出生到青年时期死亡率的关联。2022年10月19日出版的《英国医学杂志》发表了这项成果。

为了研究孕期高血压疾病（HDP）与子代从出生到青年时期的总体死亡率和特定原因死亡率的相关性，研究组根据丹麦国家健康登记册进行了一项基于全国人口的队列研究。

纳入所有1978-2018年在丹麦出生的2437718人，从出生日期到死亡、移民或2018年12月31日，以先到者为准。主要结局是全因死亡率。次要结局是从出生到青年时期（年龄41岁）的13个特定的死亡原因。考虑到几个潜在的混杂因素，使用Cox回归来评估相关性。还研究了先兆子痫发作时间和严重程度、母亲糖尿病史和母亲教育的作用。

102095名母亲患有HDP：67683例先兆子痫，679例子痫和33733例高血压。在41年（中位19.4年）的随访中，先兆子痫母亲所生的子代中有781名（58.94/100000人-年）死亡，子痫母亲所生的子代中有17名（133.73/100000人-年）死亡，高血压母亲所生的子代中有223名（44.38/100000人-年）死亡，无HDP母亲所生的子代中有19119名（41.99/100000人-年）死亡。

暴露于和未暴露于母体HDP的队列之间的总死亡率的累积发生率差异为0.37%，母体HDP的人群归因分数估计为1.09%。母体HDP与后代全因死亡率高26%（危险比为1.26）相关。孕妇先兆子痫、子痫和高血压的相应估计危险比分别为1.29、2.88和1.12。一些特定原因死亡率的风险也有所增加，例如围产期疾病（2.04）、心血管疾病（1.52）、消化系统疾病（2.09）以及内分泌、营养和代谢疾病（1.56）。在早发和重度子痫前期（6.06）或有HDP和糖尿病病史（1.57）或HDP和低教育水平（1.49）母亲的后代中，风险增加更为明显。

研究结果表明，母体HDP，尤其是子痫和严重子痫前期，与后代从出生到成年的总体死亡率和各种特定原因死亡率的风险增加相关。

附：英文原文

Title: Maternal hypertensive disorder of pregnancy and mortality in offspring from birth to young adulthood: national population based cohort study

Author: Chen Huang, Kecheng Wei, Priscilla Ming Yi Lee, Guoyou Qin, Yongfu Yu, Jiong Li

Issue&Volume: 2022/10/19

Abstract:

Objective To examine the association of maternal hypertensive disorder of pregnancy (HDP) with overall and cause specific mortality in offspring from birth to young adulthood.

Design Nationwide population based cohort study.

Setting Danish national health registers.

Participants All 2437718 individuals live born in Denmark, 1978-2018, with follow-up from date of birth until date of death, emigration, or 31 December 2018, whichever came first.

Main outcome measures The primary outcome was all cause mortality. Secondary outcomes were 13 specific causes of death in offspring from birth to young adulthood (age 41 years). Cox regression was used to assess the association, taking into consideration several potential confounders. The role of timing of onset and severity of pre-eclampsia, maternal history of diabetes, and maternal education were also studied.

Results 102095 mothers had HDP: 67683 with pre-eclampsia, 679 with eclampsia, and 33733 with hypertension. During follow-up to 41 years (median 19.4 (interquartile range 9.7-28.7) years), deaths occurred in 781 (58.94 per 100000 person years) offspring born to mothers with pre-eclampsia, 17 (133.73 per 100000 person years) born to mothers with eclampsia, 223 (44.38 per 100000 person years) born to mothers with hypertension, and 19119 (41.99 per 100000 person years) born to mothers with no HDP. The difference in cumulative incidence in overall mortality between cohorts exposed and unexposed to maternal HDP was 0.37% (95% confidence interval 0.11% to 0.64%), and the population attributable fraction for maternal HDP was estimated as 1.09% (95% confidence interval 0.77% to 1.41%). Maternal HDP was associated with a 26% (hazard ratio 1.26, 95% confidence interval 1.18 to 1.34) higher risk of all cause mortality in offspring. The corresponding estimates for maternal pre-eclampsia, eclampsia, and hypertension were 1.29 (1.20 to 1.38), 2.88 (1.79 to 4.63), and 1.12 (0.98 to 1.28). Increased risks were also observed for several cause specific mortalities, such as deaths from conditions originating in the perinatal period (2.04, 1.81 to 2.30), cardiovascular diseases (1.52, 1.08 to 2.13), digestive system diseases (2.09, 1.27 to 3.43), and endocrine, nutritional, and metabolic diseases (1.56, 1.08 to 2.27). The increased risks were more pronounced among offspring of mothers with early onset and severe pre-eclampsia (6.06, 5.35 to 6.86) or with both HDP and diabetes history (1.57, 1.16 to 2.14) or HDP and low education level (1.49, 1.34 to 1.66).

Conclusion Maternal HDP, particularly eclampsia and severe pre-eclampsia, is associated with increased risks of overall mortality and various cause specific mortalities in offspring from birth to young adulthood.

DOI: 10.1136/bmj-2022-072157

Source: https://www.bmj.com/content/379/bmj-2022-072157