慢性肾病和风险因素在子痫前期中的作用

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health Pub Date : 2024-08-18 DOI:10.1016/j.preghy.2024.101146

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引用次数: 0

摘要

背景我们的目标是确定慢性肾脏病（CKD）及其相关风险因素（如体重指数（BMI）、糖尿病和高血压）对 CKD 群体中子痫前期和其他不良妊娠结局的影响。在妇女怀孕时，收集了有关人口统计学、临床测量、体重指数、慢性肾脏病病因和其他肾脏参数的数据。结果包括子痫前期、早产和低出生体重。结果随着时间的推移，CKD 患者的孕前 BMI 有所增加，2016 年之前的中位数（四分位间范围）BMI 为 25（22-29），2016 年之后为 29（25-34）（P = 0.01）。根据分娩年份的不同，分娩年龄呈上升趋势，孕前估计肾小球滤过率（eGFR）呈下降趋势。子痫前期影响了该队列中近一半的孕妇。在多变量分析中，体重指数和慢性高血压对子痫前期、早产或低出生体重的几率没有影响，但慢性肾脏病的糖尿病病因（19/20 患有 I 型糖尿病）与子痫前期风险的显著增加有关（几率比 (OR) 7.41 (95 % CI 2.1-26.1)）。较高的孕前 eGFR 与较低的早产几率相关（OR 0.81 (95 % CI 0.67-0.98) per 10 ml/min/1.73 m2）。虽然子痫前期在慢性肾脏病患者中很常见，但其结果与 eGFR 和慢性肾脏病病因有关，而与 BMI 和慢性高血压无关。

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Role of chronic kidney disease and risk factors in preeclampsia

Background

Our goal was to identify what impact chronic kidney disease (CKD) and its associated risk factors, such as body mass index (BMI), diabetes and hypertension, have on preeclampsia and other adverse pregnancy outcomes in the CKD population.

Methods

This was a population-based cohort study of women with CKD who had a pregnancy from 2010 to 2022 (n = 95). At the time of the woman’s pregnancy, data was collected on demographics, clinical measures, BMI, CKD etiology and other renal parameters. Outcomes included preeclampsia, pre-term delivery, and low birth weight.

Results

Pre-pregnancy BMI increased over time in patients with CKD, with a median (interquartile range) BMI of 25 (22–29) prior to 2016 and 29 (25–34) after 2016 (p = 0.01). There were significant trends of increasing age at delivery and decreasing pre-pregnancy estimated glomerular filtration rate (eGFR) by delivery year. Preeclampsia affected nearly half of pregnancies in this cohort. In multivariate analyses, BMI and chronic hypertension did not impact the odds of preeclampsia, preterm delivery or low birth weight, though a CKD etiology of diabetes (19/20 with type I diabetes), was associated with a significant increase in preeclampsia risk (odds ratio (OR) 7.41 (95 % CI 2.1–26.1)). Higher pre-pregnancy eGFR was associated with a lower odds of preterm delivery (OR 0.81 (95 % CI 0.67–0.98)) per 10 ml/min/1.73 m²).

Conclusion

Pre-pregnancy BMI significantly increased over time, similar to the general population. While preeclampsia was common in CKD patients, outcomes were associated with eGFR and CKD etiology as opposed to BMI and chronic hypertension.

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来源期刊

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health OBSTETRICS & GYNECOLOGYPERIPHERAL VASCULAR-PERIPHERAL VASCULAR DISEASE

CiteScore

4.90

自引率

0.00%

发文量

127

期刊介绍： Pregnancy Hypertension: An International Journal of Women''s Cardiovascular Health aims to stimulate research in the field of hypertension in pregnancy, disseminate the useful results of such research, and advance education in the field. We publish articles pertaining to human and animal blood pressure during gestation, hypertension during gestation including physiology of circulatory control, pathophysiology, methodology, therapy or any other material relevant to the relationship between elevated blood pressure and pregnancy. The subtitle reflects the wider aspects of studying hypertension in pregnancy thus we also publish articles on in utero programming, nutrition, long term effects of hypertension in pregnancy on cardiovascular health and other research that helps our understanding of the etiology or consequences of hypertension in pregnancy. Case reports are not published unless of exceptional/outstanding importance to the field.