目的:确定妊娠早期的妊娠心血管健康(CVH)是否与不良妊娠结局的风险相关。
方法:多中心前瞻性队列;中国出生队列研究的一部分。
方法:在妊娠6-13+6周招募孕妇,并随访至分娩以确定妊娠结局。使用五个CVH指标评估妊娠早期的CVH:体重指数,吸烟,血压,葡萄糖,和脂质。多水平改进的Poisson回归模型计算了不良妊娠结局的妊娠CVH的相对风险(RRs)和95%置信区间(95%CIs)。
结果:在56,852名孕妇中,妊娠早期CVH的平均得分为9.1分.调整混杂因素,妊娠总CVH评分每降低1分,就会显著增加妊娠高血压疾病的风险(RR=1.682,95%CI:1.624-1.743),妊娠期糖尿病(RR=1.405,95%CI:1.384-1.426),早产(RR=1.184,95%CI:1.174-1.195),胎龄大(RR=1.224,95%CI:1.199-1.250),剖腹产(RR=1.073,95%CI:1.049-1.097),低Apgar评分(RR=1.131,95%CI:1.003-1.277)显着增加。同时,小于胎龄的风险降低(SGA;RR=0.922,95%CI:0.898-0.946).CVH类别恶化显著增加不良妊娠结局的风险,不包括SGA。
结论:妊娠早期不良CVH显著增加不良妊娠结局的风险,强调妊娠期CVH早期改善的必要性。
OBJECTIVE: To determine whether gestational cardiovascular health (CVH) during the first trimester is associated with a risk of adverse pregnancy outcomes.
METHODS: A multicentre prospective cohort; part of the China birth cohort study.
METHODS: Pregnant women were recruited at 6-13+6 gestation weeks and followed to delivery to identify pregnancy outcomes. Gestational CVH in the first trimester was assessed using five CVH metrics: body mass index, smoking, blood pressure, glucose, and lipids. Multilevel modified Poisson regression models calculated the relative risks (RRs) and 95% confidence intervals (95% CIs) of gestational CVH for adverse pregnancy outcomes.
RESULTS: Among 56,852 pregnant women, the mean score for gestational CVH during the first trimester was 9.1. Adjusting for confounding factors, each 1-point decrease in the total gestational CVH score significantly increased the risk of hypertensive disorders of pregnancy (RR = 1.682, 95% CI: 1.624-1.743), gestational diabetes mellitus (RR = 1.405, 95% CI: 1.384-1.426), preterm birth (RR = 1.184, 95% CI: 1.174-1.195), large for gestational age (RR = 1.224, 95% CI: 1.199-1.250), caesarean delivery (RR = 1.073, 95% CI: 1.049-1.097), and low Apgar score (RR = 1.131, 95% CI: 1.003-1.277) significantly increased. Meanwhile, the risk of small for gestational age decreased (SGA; RR = 0.922, 95% CI: 0.898-0.946). Worsened CVH categories significantly increased the risk of adverse pregnancy outcomes, excluding SGA.
CONCLUSIONS: Poor gestational CVH in the first trimester significantly increases the risk of adverse pregnancy outcomes, emphasising the need for early improvement in gestational CVH.