妊娠早期心血管代谢风险与不良妊娠结局的深圳出生队列研究

Cardio-metabolic risk and adverse pregnancy outcomes in the first trimester:findings from the Shenzhen birth cohort study

目的探讨妊娠早期心血管代谢异常与不良妊娠结局(APO)的相关性。方法本研究为队列研究。入选2021年1月1日至2022年10月31日在南方医科大学附属深圳妇幼保健院招募的妊娠早期(妊娠6~13+6周)单胎孕妇。记录妊娠早期心血管代谢指标,包括体重指数(BMI)、血压、空腹血糖(FPG)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)。记录APO发生情况,包括妊娠高血压、子痫前期、妊娠期糖尿病、早产、胎儿生长受限、小于胎龄儿、胎盘早剥。妊娠早期以下指标满足1项及以上即定义为心血管代谢异常:BMI升高(BMI≥24 kg/m^(2))、TG升高(TG≥1.7 mmol/L)、HDL-C降低(HDL-C<1.0 mmol/L)、血压升高[收缩压≥130 mmHg(1 mmHg=0.133 kPa)和(或)舒张压≥85 mmHg]、FPG升高(FPG≥5.6 mmol/L)。将入组患者分为心血管代谢异常组和心血管代谢正常组。采用Poisson回归分析妊娠早期心血管代谢异常和APO的相关性。结果最终纳入14197名孕妇,年龄(32.0±4.1)岁。心血管代谢正常组8139名,心血管代谢异常组6058例。心血管代谢异常组孕妇分娩孕周小,且早产、妊娠高血压、子痫前期、妊娠期糖尿病发生率较高(P均<0.05)。多因素Poisson回归分析结果显示,BMI升高(RR=1.22,95%CI 1.15~1.29)、FPG升高(RR=1.59,95%CI 1.38~1.82)、TG升高(RR=1.22,95%CI 1.13~1.31)、血压升高(RR=1.50,95%CI 1.39~1.63)是APO的独立危险因素,而HDL-C降低(RR=0.93,95%CI 0.70~1.23)不是APO的独立危险因素。血压升高(RR=5.57,95%CI 4.58~6.78)、BMI升高(RR=1.71,95%CI 1.40~2.09)、TG升高(RR=1.38,95%CI 1.10~1.74)是子痫前期的独立危险因素;FPG升高(RR=1.70,95%CI 1.45~1.99)对妊娠期糖尿病发生风险影响最大。结论妊娠早期血压、BMI、TG和FPG升高与APO密切相关。

Objective To investigate the relationship between cardio-metabolic abnormalities in the first trimester and adverse pregnancy outcomes(APO).Methods This cohort study recruited singleton pregnancies in the first trimester(6-13+6 weeks of gestation)from Shenzhen Maternal and Child Health Care Hospital between January 1,2021,and October 31,2022.Cardiometabolic markers,including body mass index(BMI),blood pressure,fasting plasma glucose(FPG),high-density lipoprotein cholesterol(HDL-C),and triglycerides(TG),were recorded during the first trimester.Incidence of APO,including gestational hypertension,preeclampsia,gestational diabetes mellitus,preterm birth,fetal growth restriction,small for gestational age infant,and placental abruption,was documented.Cardiovascular metabolic abnormalities in the first trimester were defined as meeting one or more of the following criteria:elevated BMI(BMI≥24 kg/m^(2)),elevated TG(TG≥1.7 mmol/L),decreased HDL-C(HDL-C<1.0 mmol/L),elevated blood pressure(systolic pressure≥130 mmHg(1 mmHg=0.133 kPa)and/or diastolic pressure≥85 mmHg),elevated FPG(FPG≥5.6 mmol/L).Enrolled women were categorized into abnormal cardio-metabolic and normal cardio-metabolic groups.Poisson regression was employed to analyze the association between cardio-metabolic abnormalities in the first trimester and APO.Results The study included 14197 pregnant women with an age of(32.0±4.1)years.There were 8139 women in the normal cardio-metabolic group and 6058 women in the abnormal cardio-metabolic group.Women with cardio-metabolic disorders in the first trimester had a younger gestational age and higher incidence rates of preterm birth,gestational hypertension,preeclampsia,and gestational diabetes mellitus(all P<0.05).In multivariable Poisson regression,elevated BMI(RR=1.22,95%CI 1.15-1.29),elevated FPG(RR=1.59,95%CI 1.38-1.82),elevated TG(RR=1.22,95%CI 1.13-1.31),and elevated blood pressure(RR=1.50,95%CI 1.39-1.63)were independent risk factors for APO,while decreased HDL-C(RR=0.93,95%CI 0.70-1.23)was not.Elevated blood pressure(RR=5.57,95%CI 4.58-6.78),elevated BMI(RR=1.71,95%CI 1.40-2.09),and elevated TG(RR=1.38,95%CI 1.10-1.74)had the greatest impact on the risk of developing preeclampsia.Elevated FPG(RR=1.70,95%CI 1.45-1.99)had the greatest impact on the risk of gestational diabetes.Conclusions Elevated blood pressure,BMI,TG and FPG in the first trimester are closely related to APO.