季节和高龄对妊娠期高血压疾病的发生及妊娠结局的影响
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摘要
目的探讨季节和高龄对妊娠期高血压疾病(HDCP)的发生以及妊娠结局的影响。方法分析2009年1月至2016年12月在广州医科大学附属第三医院产科住院分娩、且常驻地为珠江三角地区的32 602例单胎孕产妇的临床资料。按胚胎着床季节进行分组分析。结果单胎孕产妇中,HDCP总发病率为5.89%(1 921/32 602)。期间HDCP发病率呈增高趋势(P<0.05),其中轻度子痫前期发病率呈增高趋势(P<0.05),而重度子痫前期发病率呈下降趋势(P<0.05)。按产妇分娩年龄分层分析发现,适龄组(18～34岁)孕妇妊娠期高血压和重度子痫前期发病率春季显著高于夏季、秋季和冬季(P<0.05),各季节的高龄组(≥35岁)孕妇发生妊娠期高血压、轻度子痫前期和重度子痫前期的发病率均显著高于适龄组(P<0.05)。母儿近期结局比较,胎盘早剥发病率夏季显著高于春季、秋季和冬季(P<0.05),胎儿生长受限发病率秋季显著高于春季和冬季(P<0.05),新生儿轻度窒息和新生儿呼吸窘迫综合征发病率夏季显著高于春季和冬季(P<0.05)。结论高龄是HDCP发病的高危因素之一,而适龄孕产妇HDCP的发病具有季节性,以春季着床的发病率最高,且HDCP合并胎盘早剥、胎儿生长受限、新生儿轻度窒息和呼吸窘迫综合征的发病也具有季节性。
Objective To explore the impact of season and advanced maternal age on the pregnancy outcome of hypertensive disorder complicating pregnancy(HDCP). Methods The clinical data of 32 602 single-fetal pregnant women who were hospitalized in the Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Guangzhou Medical University from January 2009 to December 2016 were analyzed. Cases were grouped according to the embryo implantation season. Results Among single-born pregnant women,the total incidence of HDCP was 5.89%(1 921/32 602). The incidence of HDCP increased during the period(P<0.05),and the incidence of mild pre-eclampsia increased(P<0.05),while the incidence of severe pre-eclampsia showed a downward trend(P<0.05). According to the stratified analysis of maternal delivery age,the incidence of gestational hypertension and severe preeclampsia in pregnant women(18-34 years old)was significantly higher than that in summer,autumn and winter(P<0.05). The incidence of gestational hypertension,mild pre-eclampsia and severe pre-eclampsia in the elderly(≥35 years old)in each season was significantly higher than that in the appropriate age group(P<0.05). The incidence of placental abruption was significantly higher in summer than in spring,autumn and winter(P<0.05). The incidence of fetal growth restriction was significantly higher in autumn than in spring and winter(P<0.05). The incidence of mild asphyxia and neonatal respiratory distress syndrome in newborns was significantly higher in summer than in spring and winter(P<0.05). Conclusion Advanced age was one of the high risk factors of HDCP,and the incidence of HDCP in pregnant women is seasonal,with the highest incidence of spring implantation. And the occurrence of placental abruption,fetal growth restriction,neonatal mild asphyxia and respiratory distress syndrome in pregnant women with HDCP was also seasonal.
Objective To explore the impact of season and advanced maternal age on the pregnancy outcome of hypertensive disorder complicating pregnancy(HDCP). Methods The clinical data of 32 602 single-fetal pregnant women who were hospitalized in the Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Guangzhou Medical University from January 2009 to December 2016 were analyzed. Cases were grouped according to the embryo implantation season. Results Among single-born pregnant women,the total incidence of HDCP was 5.89%(1 921/32 602). The incidence of HDCP increased during the period(P<0.05),and the incidence of mild pre-eclampsia increased(P<0.05),while the incidence of severe pre-eclampsia showed a downward trend(P<0.05). According to the stratified analysis of maternal delivery age,the incidence of gestational hypertension and severe preeclampsia in pregnant women(18-34 years old)was significantly higher than that in summer,autumn and winter(P<0.05). The incidence of gestational hypertension,mild pre-eclampsia and severe pre-eclampsia in the elderly(≥35 years old)in each season was significantly higher than that in the appropriate age group(P<0.05). The incidence of placental abruption was significantly higher in summer than in spring,autumn and winter(P<0.05). The incidence of fetal growth restriction was significantly higher in autumn than in spring and winter(P<0.05). The incidence of mild asphyxia and neonatal respiratory distress syndrome in newborns was significantly higher in summer than in spring and winter(P<0.05). Conclusion Advanced age was one of the high risk factors of HDCP,and the incidence of HDCP in pregnant women is seasonal,with the highest incidence of spring implantation. And the occurrence of placental abruption,fetal growth restriction,neonatal mild asphyxia and respiratory distress syndrome in pregnant women with HDCP was also seasonal.
引文
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[19]黄俏雅,龚景进,黄楚君,等.高龄对胎儿生长受限的影响[J].热带医学杂志,2018,18(9):1160-1162.2019-04-15
[2]Magee LA,Pels A,Helewa M,et al.The hypertensive disorders of pregnancy(29.3)[J].Best pract Res Clin Obstet Gynaecol,2015,29(5):643-657.
[3]Von Dadelszen P,Magee LA.Preventing deaths duo to the hypertensive disorders of pregnancy[J].Best pract Res Clin Obstet Gynaecol,2016,36:83-102.
[4]Redman CW.Pre-eclampsia:A multi-stress disorder[J].Rev Med Interne,2011,32 Suppl 1:S41-44.
[5]王雁玲.胎盘发育与母胎健康[J].生命科学,2017,29(1):21-30.
[6]Weinberg CR,Shi M,Basso O,et al.Season of conception,smoking,and preeclampsia in Norway[J].Environ Health Perspect,2017,125(6):067022.
[7]Verburg PE,Dekker GA,Tucker G,et al.Seasonality of hypertensive disorders of pregnancy-A South Australianpopulation study[J].Pregnancy Hypertens,2018,12:118-123.
[8]Kahveci B,Melekoglu R,Evrukel IC,et al.The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies[J].BMC Pregnancy Childbirth,2018,18(1):343.
[9]孙雯,龚景进,陈敦金.高龄对初产妇妊娠结局影响[J].中国实用妇科与产科杂志,2016,32(12):1218-1221.
[10]谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社,2013.
[11]万淑梅,余艳红,黄莺莺,等.妊娠期高血压疾病严重并发症的发生规律及其对母儿的影响[J].中华妇产科杂志,2007,42(8):510-514.
[12]Cheng SB,Sharma S.Preeclampsia and health risks later in life:an immunological link[J].Semin Immunopathol,2016,38(6):699-708.
[13]黄淑晖,刘淮,戴龙芳,等.江西南昌地区季节性气候变化与妊娠期高血压疾病发病规律相关性研究[J].中国妇幼保健,2014,29(9):1324-1327.
[14]Nourollahpour Shiadeh M,Behboodi Moghadam Z,Adam I,et al.Human infectious diseases and risk of preeclampsia:an updated review of the literature[J].Infection,2017,45(5):589-600.
[15]Pinto JPNS,Goergen J,Muniz FWMG,et al.Vitamin D levels and risk for periodontal disease:A systematic review[J].JPeriodontal Res,2018,53(3):298-305.
[16]Kanatani KT,Adachi Y,Hamazaki K,et al.Association between vitamin D deficiency and allergic symptom in pregnant women[J].PLoS One,2019,14(4):e0214797.
[17]Downes KL,Shenassa ED,Grantz KL.Neonatal outcomes associated with placental abruption[J].Am J Epidemiol,2017,186(12):1319-1328.
[18]Macheku GS,Philemon RN,Oneko O,et al.Frequency,risk factors and feto-maternal outcomes of abruptio placentae in Northern Tanzania:a registry-based retrospective cohort study[J].BMC Pregnancy Childbirth,2018,15:242.
[19]黄俏雅,龚景进,黄楚君,等.高龄对胎儿生长受限的影响[J].热带医学杂志,2018,18(9):1160-1162.2019-04-15