孕早期血红蛋白水平及其变化与妊娠期高血压疾病的关系

The relationship of hemoglobin levels in the first trimester and its changes during pregnancy and the risk of hypertensive disorders complicating pregnancy

目的 分析孕早期血红蛋白（Hb）水平、孕期Hb水平变化与妊娠期高血压疾病（HDCP）发病风险之间的关系. 方法 孕早期（≤12周）和孕中期（24 ～28周）分别测量孕妇Hb水平,根据孕早期Hb水平将孕妇分为3组,低Hb组（100～109 g/L）、正常Hb组（110 ～ 129g/L）、高Hb组（≥130g/L）,比较3组HDCP发病率,并分析孕期Hb水平变化与HDCP发病风险的关系. 结果 共纳入10 527例孕妇进行分析,孕妇HDCP的发病率为6.2％.正常Hb组HDCP的发病率（5.7％）低于低Hb组（7.3％）和高Hb组（7.0％）.低Hb组孕妇孕中期Hb水平上升到≥130g/L时,HDCP风险上升（OR=5.36,95％ CI：1.11 ～25.81）;正常Hb组孕妇孕中期Hb水平下降到110g/L以下时,HDCP风险上升（OR=1.68,95％ CI：1.11 ～2.54）. 结论 孕早期Hb水平与HDCP的发病风险呈U型关系;孕期Hb水平发生了越级性变化时,HDCP发病风险上升,孕期将Hb水平稳定地保持在正常范围内,有助于降低HDCP的发病风险。

Objective To examine the relationship of hemoglobin （Hb） levels in the first trimester and its changes during pregnancy and the risk of hypertensive disorders complicating pregnancy （HDCP）. Methods Hb levels were measured in the first and second trimester of pregnancy. We compared the incidence of HDCP in the low （ 100-109 g/L）, normal （110-129 g/L） and high Hb groups （ I〉 130 g/L）, and analyzed the relationship between changes of Hb levels during pregnancy and the risk of HDCP. Results The overall HDCP incidence was 6.2% among 10 527 pregnant women. The incidence was 5.7% in the normal Hb group, compared to 7.3% in the low Hb group and 7.0% in the high Hb group. When the Hb level of the low Hb group increased to 130 g/L or higher, the risk of HDCP increased （ OR = 5. 36, 95 % CI： 1.11-25.81 ） ; when the Hb level of the high Hb group decreased to lower than 110 g/L, the risk of HDCP increased （0R=1.68,95% CI：1.11-2.54）. Conclusion A U-shaped relationship was fotmd between Hb levels in the first trimester of pregnancy and the risk of HDCP. A leapfrog change of gestational Hb level was a risk factor for HDCP.