心血管疾病風險的家族史會造成子癇前症


  Dec. 29, 2003--根據一項發表於十二月產科及婦產科的世代研究結果顯示,高血壓、心臟病和中風的家族史會使婦女容易發展懷孕所導致的高血壓和子癇前症。
  
  賓夕凡尼亞州匹茲堡大學的Roberta B. Ness醫師和同事表示,雖然有大量流行病學證據支持懷孕期高血壓與之後心血管風險的關聯,以家族心血管風險作為預測子癇前症的作用很少被試驗。
  
  在加入懷孕研究之後,2,211位生出活產的婦女中有85位(3.8%)發展為子癇前症,子癇前症被定義為分娩前蛋白尿加上收縮壓大於140或是舒張壓大於90,另外有142位(6.4%)發展懷孕期短暫高血壓,懷孕期短暫高血壓則被定義為分娩前血壓升高而沒有蛋白尿。
  
  家族性心血管風險被定義為家庭成員有第一級的心臟病、中風、高血壓、糖尿病或腎臟疾病,由懷孕期平均為10 .2週的面訪所測定。
  
  與沒有心血管風險家族史的女性相比,在調整了年齡和體型之後,有二名以上家人染病的婦女有大約兩倍的pre-驚厥風險(危險比1.9;95%信賴區間[CI] 1.1-3.2)和懷孕期短暫高血壓(HR1.7;95%CI 1.1-2.6)。
  有二名以上家人患有高血壓者也有加倍的子癇前症風險和懷孕期短暫高血壓,有二名以上家人患有心臟病或中風者有三倍的子癇前症風險(HR 3.2;95%CI, 1.4-7.7)。
  
  根據作者表示,這項研究的最大缺點是有家族性心血管風險而發展子癇前症或懷孕期短暫高血壓的婦女數不多。
  
  作者表示,強而有力的心血管風險家族史會增加發展子癇前症和懷孕期短暫高血壓的可能性,這些發現支持之前存在的心血管風險和特殊性高血壓會增加女性在懷孕期發展高血壓傾向的理論。

Family History of Cardiovascul

By Laurie Barclay, MD
Medscape Medical News

Dec. 29, 2003 — Family history of hypertension, heart disease and stroke predispose women to developing pregnancy-induced hypertension and preeclampsia, according to the results of a cohort study published in the December issue of Obstetrics and Gynecology.

"Although there is substantial epidemiologic evidence supporting links between hypertension in pregnancy and later cardiovascular risk, the role for familial cardiovascular risk in predicting preeclampsia has been little examined," write Roberta B. Ness, MD, MPH, from the University of Pittsburgh in Pennsylvania, and colleagues.

After enrollment in a pregnancy study, 85 (3.8%) of 2,211 women delivering live births developed preeclampsia, defined as antepartum proteinuria plus systolic blood pressure greater than 140 or diastolic blood pressure greater than 90, and 142 (6.4%) developed transient hypertension of pregnancy, defined as antepartum blood pressure elevation without proteinuria.

Familial cardiovascular risk was defined as having first-degree family members with heart disease, stroke, hypertension, diabetes, or renal disease, as determined from an interview conducted at a mean of 10.2 weeks' gestation.

Compared with women who had no family history of cardiovascular risk, women with two or more affected family members had nearly twice the risk of pre-eclampsia (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.1-3.2) and transient hypertension of pregnancy (HR, 1.7; 95% CI 1.1-2.6), after adjustment for age and body size. Having two or more family members with hypertension also doubled the risk of preeclampsia and transient hypertension of pregnancy, and having two or more family members with heart disease or stroke tripled the risk of preeclampsia (HR. 3.2; 95% CI, 1.4-7.7).

The greatest weakness of this study, according to the authors, is the limited number of women with familial cardiovascular risk who developed preeclampsia or transient hypertension of pregnancy.

"A strong family history of aggregate cardiovascular risk increased the likelihood for developing preeclampsia and transient hypertension of pregnancy," the authors write. "These findings support the theory that a preexisting tendency to cardiovascular risk, and particularly hypertension, increases a women's susceptibility to developing hypertension in pregnancy."

Obstet Gynecol. 2003;102(6):1366-1371

Reviewed by Gary D. Vogin, MD

    
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