Abstract：
BACKGROUND: Gestational hypertension (GHTN) and preeclampsia are established risk indicators for chronic hypertension. While recurrence is associated with a greater risk, it is unclear whether there are differences in risk when these gestational complications occur for the first time in an earlier pregnancy versus first occurrence in a subsequent one. We hypothesized that the absence of recurrence reflects a transition toward a lower hypertension risk trajectory, whereas a new occurrence in a later pregnancy indicates a transition toward elevated risk.
RESULTS: We analyzed linked data in Quebec, Canada, from public health care insurance administrative databases and birth, stillbirth, and death registries. Our retrospective cohort study included mothers with 2 singleton deliveries between April 1990 and December 2012. The primary exposure was patterns of GHTN or preeclampsia across 2 pregnancies (GHTN/preeclampsia in neither, first only, second only, or both). The outcome was incident chronic hypertension. We performed an adjusted multivariable Cox regression analysis. Among 431 980 women with 2 singleton pregnancies, 27 755 developed hypertension during the follow-up period. Compared with those without GHTN/preeclampsia, those with GHTN/preeclampsia only in the first pregnancy had a 2.7-fold increase in hazards (95% CI, 2.6-2.8), those with GHTN/preeclampsia only in the second had a 4.9-fold increase (95% CI, 4.6-5.1), and those with GHTN/preeclampsia in both pregnancies experienced a 7.3-fold increase (95% CI, 6.9-7.6). Patterns and estimates were similar when we considered GHTN and preeclampsia separately.
CONCLUSIONS: The magnitude of hypertension risk is associated with the number and sequence of GHTN/preeclampsia-affected pregnancies. Considering both allows more personalized risk estimates.
RESULTS: We analyzed linked data in Quebec, Canada, from public health care insurance administrative databases and birth, stillbirth, and death registries. Our retrospective cohort study included mothers with 2 singleton deliveries between April 1990 and December 2012. The primary exposure was patterns of GHTN or preeclampsia across 2 pregnancies (GHTN/preeclampsia in neither, first only, second only, or both). The outcome was incident chronic hypertension. We performed an adjusted multivariable Cox regression analysis. Among 431 980 women with 2 singleton pregnancies, 27 755 developed hypertension during the follow-up period. Compared with those without GHTN/preeclampsia, those with GHTN/preeclampsia only in the first pregnancy had a 2.7-fold increase in hazards (95% CI, 2.6-2.8), those with GHTN/preeclampsia only in the second had a 4.9-fold increase (95% CI, 4.6-5.1), and those with GHTN/preeclampsia in both pregnancies experienced a 7.3-fold increase (95% CI, 6.9-7.6). Patterns and estimates were similar when we considered GHTN and preeclampsia separately.
CONCLUSIONS: The magnitude of hypertension risk is associated with the number and sequence of GHTN/preeclampsia-affected pregnancies. Considering both allows more personalized risk estimates.
摘要：
背景：妊娠高血压（GHTN）和先兆子痫是慢性高血压的既定风险指标。虽然复发与更大的风险相关，目前尚不清楚这些妊娠并发症在早期妊娠中首次发生与在随后的妊娠中首次发生时的风险是否存在差异.我们假设没有复发反映了向较低高血压风险轨迹的转变，而在怀孕后期出现的新情况表明向高风险过渡。
结果：我们分析了魁北克的关联数据，加拿大,从公共医疗保险管理数据库和出生，死产,和死亡登记处。我们的回顾性队列研究包括1990年4月至2012年12月期间2例单胎分娩的母亲。主要暴露是2例妊娠中的GHTN或先兆子痫（GHTN/先兆子痫，首先,第二，或两者)。结果是慢性高血压。我们进行了校正多变量Cox回归分析。在431980名女性中，有2次单胎怀孕，27755在随访期间出现高血压。与没有GHTN/先兆子痫的患者相比，仅在第一次怀孕时患有GHTN/先兆子痫的人的危害增加了2.7倍（95％CI，2.6-2.8），仅在第二次患有GHTN/先兆子痫的患者增加了4.9倍（95％CI，4.6-5.1），两次妊娠中GHTN/先兆子痫患者均增加7.3倍(95%CI,6.9-7.6).当我们分别考虑GHTN和先兆子痫时，模式和估计是相似的。
结论：高血压风险的大小与受GHTN/先兆子痫影响的妊娠的数量和顺序有关。考虑到这两者，可以进行更个性化的风险估计。
结果：我们分析了魁北克的关联数据，加拿大,从公共医疗保险管理数据库和出生，死产,和死亡登记处。我们的回顾性队列研究包括1990年4月至2012年12月期间2例单胎分娩的母亲。主要暴露是2例妊娠中的GHTN或先兆子痫（GHTN/先兆子痫，首先,第二，或两者)。结果是慢性高血压。我们进行了校正多变量Cox回归分析。在431980名女性中，有2次单胎怀孕，27755在随访期间出现高血压。与没有GHTN/先兆子痫的患者相比，仅在第一次怀孕时患有GHTN/先兆子痫的人的危害增加了2.7倍（95％CI，2.6-2.8），仅在第二次患有GHTN/先兆子痫的患者增加了4.9倍（95％CI，4.6-5.1），两次妊娠中GHTN/先兆子痫患者均增加7.3倍(95%CI,6.9-7.6).当我们分别考虑GHTN和先兆子痫时，模式和估计是相似的。
结论：高血压风险的大小与受GHTN/先兆子痫影响的妊娠的数量和顺序有关。考虑到这两者，可以进行更个性化的风险估计。
