妊娠高血压综合征孕妇母婴结局及其影响因素研究

Maternal and infant outcomes of pregnancy-induced hypertension syndrome and its influencing factors

目的探讨妊娠高血压综合征(PIH)母婴结局及其影响因素,为避免特殊人群发生不良分娩结局提供科学依据。方法以2017年6月至2020年5月在北京市某医院建立产前健康档案且在该医院分娩的PIH孕妇作为研究对象,收集PIH患者确诊为PIH时的相关生理生化指标及分娩情况,采用描述流行病学分析方法对PIH孕妇不良分娩结局进行分析,并采用单、多因素分析方法对该人群不良分娩结局相关因素进行分析。结果研究时间内收集到诊断为PIH的孕妇有效病例274例,年龄23~43岁,以23~34岁为主,占63.87%。初产妇占60.95%,定期产检者占94.89%,高血压家族史者占29.93%。不良母婴结局发生率为31.39%(86/274),其中胎盘早剥27例,产后出血23例,产后感染8例,羊水过少6例,胎儿宫内窘迫12例,新生儿窒息10例。疾病程度为中度或重度(OR=2.042、2.305)、尿蛋白程度为+++或++++(OR=2.550、2.942)、合并甲减(OR=2.686)、有吸烟史(OR=2.968)及低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白A1、血管内皮生长因子、可溶性血管内皮生长因子受体1异常者(OR=1.446、1.726、1.976、2.430、1.774)发生不良母婴结局风险较高,发病孕周≥37周(OR=0.515)、分娩孕周≥37周者(OR=0.506)发生不良母婴结局风险较小。结论 PIH患者发生不良分娩结局风险较高,可能影响分娩结局的因素较多,建议应针对该人群相关危险因素加强监测并制定相关预防控制措施,避免不良母婴结局发生。

Objective To explore the maternal and infant outcomes of pregnancy-induced hypertension syndrome(PIH)and its influencing factors,so as to provide scientific basis for avoiding adverse delivery outcomes in special populations. Methods The PIH gravida who established prenatal health records in a hospital in Beijing from June 2017 to May2020 and gave birth in the hospital were used as the research object to collect the relevant physiological and biochemical indicators and delivery status of PIH patients when they were diagnosed with PIH. Descriptive epidemiological analysis was used to analyze the adverse delivery outcomes of PIH gravida,and univariate and multivariate analysis methods were used to analyze the related factors of the population’s adverse delivery outcomes. Results A total of 274 effective cases of gravida diagnosed with PIH was collected during the study period,aged 23-43 years old,mainly 23-34 years old,accounting for 63.87%. Primiparas accounted for 60.95%,regular obstetric checkups accounted for 94.89%,and family history of hypertension accounted for 29.93%. The incidence of adverse maternal and infant outcomes was 31.39%(86/274),including27 cases of placental abruption,23 cases of postpartum hemorrhage,8 cases of postpartum infection,6 cases of oligohydramnios,12 cases of fetal distress,and 10 cases of neonatal asphyxia. The degree of disease was moderate or severe(OR=2.042,2.305),the degree of urine protein was +++ or ++++(OR=2.550,2.942),combined with hypothyroidism(OR=2.686),a history of smoking(OR= 2.968)and those with abnormal LDL-C,HDL-C,ApoA1,VEGF,sVEGFR-1(OR=1.446,1.726,1.976,2.430,1.774)had a higher risk of adverse maternal and infant outcomes. Gestational age at onset≥37 weeks(OR=0.515),and those with delivery gestational age ≥37 weeks(OR=0.506)had a lower risk of adverse maternal and infant outcomes. Conclusion PIH patients have a higher risk of adverse delivery outcomes,and there are many factors that may affect delivery outcomes. It is recommended that the relevant risk factors of this population should be monitored and related prevention and control measures should be formulated to avoid adverse maternal and infant outcomes.