OBJECTIVE: To assess the 5-year risk of cardiovascular events and all-cause mortality in women with gestational diabetes and hypertension.
METHODS: Retrospective study utilising an health research network(TriNetX). The primary outcome was the composite risk of a cardiovascular event within 5 years with secondary outcomes being its components (all-cause death, acute heart failure, myocardial infarction, ischaemic stroke). Women were categorised into 8 different groups based on the ICD-codes for pregnancy related complications recorded 9 months before the delivery:1) gestational diabetes,2) gestational hypertension,3) gestational diabetes with gestational hypertension,4) gestational diabetes with gestational hypertension without pre-eclampsia or eclampsia,5) gestational diabetes with pre-eclampsia or eclampsia,6) gestational hypertension without pre-eclampsia or eclampsia,7) pre-eclampsia or eclampsia,and 8) no gestational complications. Cox-regression analyses were used to produce hazard ratios (HRs) and 95 % confidence intervals (CI) before and after propensity score matching (PSM).
RESULTS: We identified, 24,402 women with gestational diabetes and gestational hypertension and 920,478 without gestational complications. After PSM, compared to women without pregnancy complications, women with gestational diabetes and gestational hypertension had a higher 5-year risk of composite outcome(HR 2.25,95 %CI 2.02-2.51), all-cause death(HR 1.64,95 %CI 1.31-2.06), acute heart failure(HR 2.06,95 %CI 1.69-2.52), myocardial infarction(HR 2.46,95 %CI 1.93-3.14), and ischemic stroke(HR 2.37,95 %CI 2.06-2.74). Women who experienced pre-eclampsia or eclampsia showed the highest risk of primary and secondary outcomes.
CONCLUSIONS: Gestational complications are associated with worse long-term cardiovascular outcomes. There is a clear call to action required to improve the longitudinal management of gestational complications to improve women\'s long-term health.
目的:评估妊娠糖尿病和高血压妇女5年心血管事件和全因死亡率的风险。
方法:使用健康研究网络(TriNetX)进行回顾性研究。主要结局是5年内心血管事件的复合风险,次要结局是其组成部分(全因死亡,急性心力衰竭,心肌梗塞,缺血性中风)。根据分娩前9个月记录的妊娠相关并发症的ICD代码,将妇女分为8个不同的组:1)妊娠糖尿病,2)妊娠期高血压,3)妊娠期糖尿病合并妊娠期高血压,4)妊娠期糖尿病合并妊娠期高血压,无先兆子痫或子痫,5)妊娠糖尿病伴先兆子痫或子痫,6)妊娠期高血压无先兆子痫或子痫,7)先兆子痫或子痫,8)无妊娠并发症。在倾向评分匹配(PSM)之前和之后,使用Cox回归分析来产生风险比(HR)和95%置信区间(CI)。
结果:我们确定,24,402名患有妊娠期糖尿病和妊娠期高血压的妇女和920,478名没有妊娠期并发症的妇女。PSM之后,与没有妊娠并发症的女性相比,妊娠期糖尿病和妊娠期高血压的女性5年复合结局风险较高(HR2.25,95CI2.02-2.51),全因死亡(HR1.64,95CI1.31-2.06),急性心力衰竭(HR2.06,95CI1.69-2.52),心肌梗死(HR2.46,95CI1.93-3.14),和缺血性卒中(HR2.37,95CI2.06-2.74)。经历先兆子痫或子痫的女性表现出最高的主要和次要结局风险。
结论:妊娠并发症与不良的长期心血管结局相关。有一个明确的呼吁需要采取行动,以改善妊娠并发症的纵向管理,以改善妇女的长期健康。