早期降压治疗对妊娠合并轻中度慢性高血压患者妊娠结局的影响

Effect of early anti-hypertensi ve treatment on pregnancy outcomes of pregnant women with pregnancy associated with mild to moderate chronic hypertension

目的探讨早期降压治疗对妊娠合并轻中度慢性高血压(简称慢高)患者母儿结局的影响。方法回顾性分析2015年1月至2019年12月在昆山市第一人民医院产科高血压门诊治疗的548例妊娠合并轻中度慢高孕产妇资料。孕早期(孕周<14周)即开始进行降压治疗者作为治疗组,共336例(61.31%);孕早期未接受降压治疗者作为对照组,共212例(38.69%)。两组建卡后均接受小剂量肠溶阿司匹林片(LDA)进行治疗。分析早期降压治疗对母儿相关结局(子痫前期、分娩方式、胎儿生长受限、早产、出生体重)的影响。结果治疗组年龄≥35岁(χ2=4.560)、有慢高史(χ2=36.400)、体质量指数(BMI)≥28.0kg/m2(χ2=5.210)、规律产检(χ2=5.480)的孕产妇比例均明显高于对照组,差异均有统计学意义(均P<0.05)。两组在分娩孕周<34周、34~37周、>37周中所占比例差异有统计学意义(χ2=10.170,P<0.05)。治疗组剖宫产、子痫前期的发生率均高于对照组,差异均有统计学意义(χ2值分别为4.510、15.770,均P<0.05)。在调整了产妇年龄、受教育程度、慢高史及初次产检时血压水平等因素后,多因素Logistic回归分析结果显示早期降压治疗对早产(OR=1.31,95%CI:0.82~2.09)、胎儿生长受限(OR=1.70,95%CI:0.96~2.99)、剖宫产(OR=1.47,95%CI:0.98~2.20)、低出生体重(OR=1.72,95%CI:0.83~3.53)的影响均无统计学意义(均P>0.05),但可降低52.00%的子痫前期发生(OR=0.48,95%CI:0.34~0.70,P<0.05)。结论对轻中度慢高产妇孕早期实施降压治疗,可明显降低子痫前期的发生,并不影响围产儿结局。因此,在临床实践中对轻中度慢高产妇应尽早发现,积极开展降压治疗以优化母婴结局。

Objective To investigate effect of early anti-hypertensive treatment on maternal and fetal outcomes of pregnant women with pregnancy associated with mild to moderate chronic hypertension(CH).Methods The clinical data of 548 pregnant women who underwent prenatal examination and were diagnozed as pregnancy associated with mild to moderate primary CH and received pospartum follow-up in obstetric hypertension clinic of The First Kunshan Municipal People’s Hospital over a period from 2015 to 2019 were retrospectively analyzed.336(61.31%) pregnant women with mild to moderate CH started to receive anti-hypertensive medicine since early pregnancy(<14 weeks of gestational age)(treatment group) and 212(38.69%) pregnant women didn’t take any anti-hypertensive medicine in early pregnancy(control group).All pregnant women were given low dose(50 mg) aspirin(LDA).Logistic regression model was used to explore effects of anti-hypertensive treatment on maternal and fetal outcomes including pre-eclampsia(PE),delivery pattern,fetal growth restriction(FGR),premature delivery and birth weight.Results(1) The proportions of those pregnant women with age≥ 35 years(χ2=4.560),having history of CH(χ2=36.400),with body mass index(BMI) ≥28.0(kg/m2)(χ2=5.210) and receiving regular prenatal examination(χ2=5.480) in the treatment group were significant higher than those in the control group(all P<0.05).In addition,in proportions of the pregnant women who delivered at <34 weeks of gestational age,at 34~37 weeks of gestational age and at >37 weeks of gestational age,there were all significant differences between the two groups(χ2=10.170,P<0.05).The incidence rates of ceserean section(CS) and PE in the treatment group were both higher than those in the control group(χ2 =4.510 and 15.770 respectively,both P<0.05).(2) After adjusting confounding factors such as age,educational level,history of CH and blood pressure at the first prenantal examination of the pregnant wmomen,logistic regression analysis demonstrated that anti-hypertensive treatment in early pregnancy could lower 52% of incidence of PE(OR=0.48,95%CI:0.34~0.70),while the treatment had no effects on incidence rates of low birth weight(OR=1.72,95%CI:0.83~3.53),FGR(OR=1.70,95%CI:0.96~2.99),preterm delivery(OR=1.31,95%CI:0.82~2.09) and CS(OR=1.47,95%CI:0.98~2.20),and no significant associations were found(all P>0.05).Conclusion The anti-hypertensive treatment in the early stage of pregnancy for those pregnant women with mild to moderate CH can reduce incidence of PE without detriment to maternal and fetal outcomes.Therefore,early identification and initial anti-hypertensive treatment for pregnancy associated with mild to moderate primary CH should be done to optimize maternal and fetal outcomes ultimately.