Abstract：
BACKGROUND: . The long-term impact of gestational complications on cardiovascular outcomes in women remains a subject of debate.
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.
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.
摘要：
背景：妊娠并发症对女性心血管结局的长期影响仍然是一个争论的话题。
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。
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。
