妊娠剧吐与妊娠期高血压疾病的相关性研究
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摘要
目的:探讨妊娠剧吐与妊娠期高血压疾病(HDCP)的相关性。方法:采用前瞻性研究方法,随访114例妊娠剧吐患者的转归及HDCP的发病情况;同时随访154例孕早期正常孕妇的临床资料作为对照。分析两组孕妇HDCP的发生情况及相关危险因素。结果:114例妊娠剧吐患者中发生HDCP者19例,发生率16.7%,明显高于正常孕妇(7.8%)(12/154,P=0.025)。妊娠剧吐患者发生HDCP的相对危险度为2.14,95%置信区间(CI)为1.08～4.23。Logistic回归模型调整年龄、产次和体重指数(BMI)因素后,妊娠剧吐患者发生HDCP的风险增加(OR=2.84,95%CI为1.25～6.49)。妊娠剧吐组中,19例后期发生HDCP者的平均年龄为(25.21±1.65)岁,明显小于未发生HDCP者[(28.39±3.18)岁],差异有统计学意义(P<0.001)。Logistic回归模型调整了产次和BMI后,年龄<25岁的妊娠剧吐患者易发生HDCP(OR=0.33,95%CI为0.13～0.83)。结论:妊娠剧吐患者在孕晚期发生HDCP的风险增加;孕期保健过程中应加强对此类患者的管理。
Objective:To investigate the correlation between hyperemesis gravidarum and hypertensive disorders in pregnancy.Methods:The method of prospective study,follow-up the outcome and incidence of hypertensive disorders during pregnancy of 114 patients with HG.At the same time,the clinical datas of 154 normal pregnant women in early pregnancy were followed up as control.The incidence and risk factors of the HDCP were analyzed.Results: Among 114 patients with HG,HDCP occurred in 19 cases(16.7%),was significantly higher than normal pregnancies(7.8%,P=0.025).Further analysis,relative risk of HG developing HDCP in the future was 2.14,95% confidence interval(CI) was 1.08～4.23.Logistic regression model adjusted for age,parity and Body mass index(BMI),patients with HG have an increased risk of HDCP(OR=2.84,95%CI:1.25～6.49).In HG group,the mean age of the 19 patients who developed HDCP in late was(25.21±1.65) years,significantly less than patients without HDCP[(28.39±3.18)years],the difference was statistically significant(P<0.001).Logistic regression model adjusted for parity and BMI,patients younger than 25 years of HG are more likely to hypertensive disease(OR=0.33,95%CI:0.13～0.83).Conclusions:Patients with HG are increased risk of developing HDCP later in pregnancy.In the process of prenatal care,the management of the patients should be strengthened.
Objective:To investigate the correlation between hyperemesis gravidarum and hypertensive disorders in pregnancy.Methods:The method of prospective study,follow-up the outcome and incidence of hypertensive disorders during pregnancy of 114 patients with HG.At the same time,the clinical datas of 154 normal pregnant women in early pregnancy were followed up as control.The incidence and risk factors of the HDCP were analyzed.Results: Among 114 patients with HG,HDCP occurred in 19 cases(16.7%),was significantly higher than normal pregnancies(7.8%,P=0.025).Further analysis,relative risk of HG developing HDCP in the future was 2.14,95% confidence interval(CI) was 1.08～4.23.Logistic regression model adjusted for age,parity and Body mass index(BMI),patients with HG have an increased risk of HDCP(OR=2.84,95%CI:1.25～6.49).In HG group,the mean age of the 19 patients who developed HDCP in late was(25.21±1.65) years,significantly less than patients without HDCP[(28.39±3.18)years],the difference was statistically significant(P<0.001).Logistic regression model adjusted for parity and BMI,patients younger than 25 years of HG are more likely to hypertensive disease(OR=0.33,95%CI:0.13～0.83).Conclusions:Patients with HG are increased risk of developing HDCP later in pregnancy.In the process of prenatal care,the management of the patients should be strengthened.
引文
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[13] 李霞,张师前.美国妇产科医师协会“妊娠期恶心呕吐诊治指南 2018版”解读[J].中国实用妇科与产科杂志,2018,34(4):409-412
[14] Lepage N,Chitayat D,Kingdom J,et al.Association between second-trimester isolated high maternal serum maternal serum human chorionic gonadotropin levels and obstetric complications in singleton and twin pregnancies[J].Am J Obstet Gynecol,2003,188(5):1354-1359
[15] Chen JZ,Sheehan PM,Brennecke SP,et al.Vessel remodelling,pregnancy hormones and extravillous trophoblast function[J].Mol Cell Endocrinol,2012,349(2):138-144
[16] 滕晓慧,潘石蕾.孕妇年龄与妊娠高危因素及妊娠结局的关系[J].实用妇产科杂志,2017,33(9):692-696
[17] Fleming N,Ng N,Osborne C,et al.Adolescent pregnancy outcomes in the province of Ontario:a cohort study [J].J Obstet Gynaecol Can,2013,35(3):234-245
[2] Bolin M,Akerud H,Cnattingius S,et al.Hyperemesis gravidarum and risks of placental dysfunction disorders:a population-based cohort study[J].BJOG,2013,120(5):541-547
[3] Vandraas KF,Vikanes AV,Vangen S,et al.Hyperemesis gravidarum and birth outcomes-a population-based cohort study of 2.2 million births in the Norwegian Birth Registry [J].BJOG,2013,120(13):1654-1660
[4] Fiaschi L,Nelson-Piercy C,Gibson J,et al.Adverse Maternal and Birth Outcomes in Women Admitted to Hospital for Hyperemesis Gravidarum:a Population-Based Cohort Study [J].Paediatr Perinat Epidemiol,2018,32(1):40-51
[5] 中华医学会妇产科学分会产科学组.妊娠剧吐的诊断及临床处理专家共识(2015)[J].中华妇产科学杂志,2015,11(50):801-804
[6] 中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2015)[J].中华妇产科学杂志,2015,10(50):721-728
[7] Kuru O,Sen S,Akbayir O,et al.Outcomes of pregnancies complicated by hyperemesis gravidarum [J].Arch Gynecol Obstet,2012,285(6):1517-1521
[8] Koudijs HM,Savitri AI,Browne JL,et al.Hyperemesis gravidarum and placental dysfunction disorders [J].BMC Pregnancy Childbirth,2016,16(1):374
[9] London V,Grube S,Sherer DM,et al.Hyperemesis gravidarum:a review of recent literature [J].Pharmacol,2017,100(3-4):161-171
[10] Grooten IJ,Den Hollander WJ,Roseboom TJ,et al.Helicobacter pylori infection:a predictor of vomiting severity in pregnancy and adverse birth outcome[J].Am J Obstet Gynecol,2017,216(5):512.e1-e9
[11] Goymen A,Ozduraki,Ozkaplan SE,et al.The relationship between the helicobacter pylori seropositivity with systemic and local oxidative status and hyperemesis gravidarum:a pilot study [J].J Matern Fetal Neonatal Med,2018,31(9):1204-1208
[12] Di Simone N,Tersigni C,Cardaropoli S,et al.Helicobacter pylori infection contributes to placental impairment in preeclampsia:basic and clinical evidences[J].Helicobacter,2017,22(2) doi:10.1111/hel.12347
[13] 李霞,张师前.美国妇产科医师协会“妊娠期恶心呕吐诊治指南 2018版”解读[J].中国实用妇科与产科杂志,2018,34(4):409-412
[14] Lepage N,Chitayat D,Kingdom J,et al.Association between second-trimester isolated high maternal serum maternal serum human chorionic gonadotropin levels and obstetric complications in singleton and twin pregnancies[J].Am J Obstet Gynecol,2003,188(5):1354-1359
[15] Chen JZ,Sheehan PM,Brennecke SP,et al.Vessel remodelling,pregnancy hormones and extravillous trophoblast function[J].Mol Cell Endocrinol,2012,349(2):138-144
[16] 滕晓慧,潘石蕾.孕妇年龄与妊娠高危因素及妊娠结局的关系[J].实用妇产科杂志,2017,33(9):692-696
[17] Fleming N,Ng N,Osborne C,et al.Adolescent pregnancy outcomes in the province of Ontario:a cohort study [J].J Obstet Gynaecol Can,2013,35(3):234-245