糖尿病女性妊娠早期白大衣高血压发生率及其与妊娠期高血压关系的研究

Study on the incidence of white coat hypertension in early pregnancy of diabetic women and its relationship with hypertension in pregnancy

目的了解既往患有糖尿病的女性在妊娠早期白大衣高血压(WCH)的发生率及其与妊娠期高血压的相关性。方法从2017年9月到2019年7月,连续纳入了妊娠前患有糖尿病的孕妇222例。在初次产检时测量患者诊室血压。培训合格后的患者及其家属一周内在家中连续3天每天早、中、晚测量3次家庭血压。在孕36周后的1周内用同样的方法测量家庭血压。新检测到的诊室收缩压≥140mmHg和/或舒张压≥90mmHg,家庭血压收缩压<135mmHg和舒张压<80mmHg定义为WCH。将患者分为WCH组、慢性高血压组和正常血压组。结果 12.3%(n=27)的糖尿病患者在妊娠早期出现WCH,其中12例(44.4%)进展为妊娠期高血压。与正常血压组患者相比较,WCH组和慢性高血压组患者的BMI、2型糖尿病患者比例显著增高,差异有统计学意义(P<0.05)。WCH女性的新生儿平均出生体重z值低于正常血压妇女的子代,差异有统计学意义(P=0.006)。各组间分娩时的孕周或早产人数差异无统计学意义(P>0.05)。多因素Logestic回归分析发现,妊娠早期存在WCH的患者发生妊娠期高血压病的风险是妊娠早期未发生WCH患者的2倍(OR:2.43,95%CI:1.56,6.89,P=0.002)。WCH患者是否发展为妊娠期高血压,与所有妊娠早期临床变量无关(P>0.05)。结论既往患有糖尿病的女性在妊娠早期发生WCH的比例较高,且容易发展成为妊娠期高血压。这类人群在妊娠早期产检发现诊室血压升高时,建议重复监测家庭血压。

Objective to investigate the incidence of white coat hypertension in early pregnancy in women with preexisting diabetes mellitus and its association with hypertension during pregnancy.Methods From September 2017 to July 2019,222 pregnant women with pre-pregnancy diabetes were included.Measure blood pressure in the patient’s office during the first delivery.After the training,the patients and their family members had their blood pressure measured 3 times in the morning,at noon and at night for 3 consecutive days in the home for a week.Family blood pressure was measured in the same way at 1 week after 36 weeks of pregnancy.The newly detected systolic blood pressure in the clinic≥140 mmHg and/or diastolic blood pressure≥90 mmHg,and the family systolic blood pressure<135 mmHg and diastolic blood pressure<80 mmHg were defined as white coat hypertension.The patients were divided into white coat hypertension group,chronic hypertension group and normal blood pressure group.Results 12.3%(n=27)of diabetic patients developed hypertension in the early pregnancy,and 12(44.4%)of them developed hypertension during pregnancy.Compared with the normal blood pressure group,the proportion of BMI and type 2 diabetes was significantly increased in the white-coat hypertension group and the chronic hypertension group,and the difference was statistically significant(P<0.05).The mean birth weight z value of newborns in women with white coat hypertension was lower than that in children of women with normal blood pressure,and the difference was statistically significant(P=0.006).There was no significant difference in the number of gestational weeks or preterm births between the groups(P>0.05).Multivariate Logistic regression analysis found that patients with white coat hypertension in early pregnancy had twice the risk of developing gestational hypertension compared with patients without white coat hypertension in early pregnancy(OR:2.43,95%CI:1.56,6.89,P=0.002).Whether patients with white coat hypertension developed gestational hypertension was independent of all early pregnancy clinical variables(P>0.05).Conclusion Women with prior diabetes had a higher proportion of white-coat hypertension in early pregnancy and were more likely to develop gestational hypertension.Repeated monitoring of blood pressure in the home is recommended for those in this group who have elevated blood pressure at the clinic during the first trimester.