妊娠期高血压疾病对小于胎龄儿的影响及潜在交互作用研究

Influence of hypertension disorder complicating pregancy and its interaction with other factors on incidence of small for gestational age

目的 研究妊娠期高血压疾病对小于胎龄儿的影响及潜在交互作用。方法 采用巢式病例对照研究方法分析妊娠期高血压疾病对小于胎龄儿的影响，评价妊娠期高血压疾病与其他因素之间的交互作用；单因素分析采用χ2检验，多因素分析及相乘交互作用采用非条件logistic回归分析。结果 共收集单胎活产孕妇6 297例，其中妊娠期高血压疾病发生率为13.28%（836/6 297），小于胎龄儿发生率为12.53%（789/6 297）。与非妊娠期高血压疾病孕妇相比，妊娠期高血压孕妇（aOR=2.185，95% CI：1.266～3.770）、子痫前期/子痫孕妇（aOR=5.322，95% CI：4.224～6.707）及慢性高血压并发子痫前期孕妇（aOR=3.794，95% CI：2.190～6.573）发生小于胎龄儿的危险均明显升高。妊娠期高血压疾病与早产对小于胎龄儿的交互作用超额相对危险度（RERI）、交互作用归因比（AP）和交互作用指数（SI）分别为5.260、0.586和2.941，存在较为明显的相加交互作用及相乘交互作用（OR=2.331，95% CI：1.443～3.767）；妊娠期高血压疾病与胎盘早剥（RERI=5.631，AP=0.522，SI=2.352）、胎儿性别为女（RERI=3.660，AP=0.374，SI=1.714）、羊水偏少（RERI=10.619，AP=0.636，SI=3.093）均存在相加交互作用，未发现存在相乘交互作用。结论 妊娠期高血压疾病是发生小于胎龄儿的危险因素，且与胎盘早剥、胎儿性别为女、羊水偏少均存在相加交互作用，与早产存在相加及相乘交互作用。

Objective To understand the influence of hypertension disorder complicating pregancy on the incidence of small for gestational age （SGA） and its interaction with other factors. Methods A nested case-control study was conducted to analyze the influence of hypertension disorder complicating pregancy on the incidence of small for gestational age and evaluate the interaction between hypertension disorder complicating pregancy and other factors. Results Data from 6 297 subjects were collected, including 836 （13.28%） pregnant women with hypertension disorder complicating pregancy, 789 （12.53%） infants who were small for gestational age. Compared with the pregnant women without hypertension disorder complicating pregancy, women with hypertension disorder complicating pregancy （aOR=2.185, 95%CI：1.266-3.770）, preeclampsia-eclampsia （aOR=5.322, 95%CI：4.224-6.707） and with chronic hypertension complicated with superimposed preeclampsia （aOR=3.794, 95%CI：2.190-6.573） had increased risk for the incidence of small for gestational age. The Interaction analysis showed that there was strong positive interactions between hypertension disorder complicating pregancy and premature birth on small for gestational age infants （RERI=5.260, AP=0.586, SI=2.941）, （OR=2.331, 95%CI：1.443-3.767）. Addictive interaction was found between hypertension disorder complicating pregancy and placental abruption （RERI=5.631, AP=0.522, SI=2.352）, and between hypertension disorder complicating pregancy and female fetuses （RERI=3.660, AP=0.374, SI=1.714）, and between hypertension disorder complicating pregancy and oligohydramnios （RERI=10.619, AP=0.636, SI=3.093）. However, no significant multiplication interaction was found. Conclusions Hypertension disorder complicating pregancy is the risk factor of the incidence of small for gestational age. Hypertension disorder complicating pregancy also showed addictive interaction on the incidence of small for gestational age with female fetuses, placental abruption as well as oligohydramnios. There was addictive and multiplication interactions between hypertension disorder complicating pregancy and premature birth.