懷孕時期的併發症與隨後可能產生中風的風險有關


  Sept. 29, 2005(聖地牙哥)-根據研究調查學者在美國神經學協會第130屆年會上發表的研究發現,在懷孕期間產生某些併發症,可能使得婦女在後來幾年增加中風的風險。
  
  罹患過妊娠併高血壓及妊娠期的糖尿病婦女將較無此併發症者高出兩倍中風的風險;研究調查學者表示,醫師應僅早提供有此併發症孕婦相關諮詢,以降低其中風因素。
  
  發表此項研究之學者為Cheryl Bushnell醫學博士,他是北卡羅來納州杜罕市的杜克大學醫學中心研究腦血管疾病杜克中心的醫學系副教授;他表示,在這些罹患此有害妊娠併發症的人口中,可能有一個子集的婦女屬高風險群,這些人口可能需要較早的介入治療;然而,到底是哪些有此併發症婦女屬之,仍在研究中。
  
  Bushnell博士表示,目前醫師應緊密監測有此併發症婦女,並格外需要幫助他們減少任何其他可能造成中風危險的因素,例如高血壓、高膽固醇,抽菸以及飲食與運動等方面問題。
  
  雖然先前研究顯示妊娠併高血壓會引發晚年時的心血管疾病,但並無決定性研究結果顯示與中風有關,因此研究調查學者進行這項研究;他們的控制個案研究所使用的資料是來自杜克大學醫學中心產期與健康服務結果的資料庫;這資料庫包括所有42,263名在1979-2005年間於該校教學醫院生產的婦女。
  
  研究學者認定之併發症包括胎盤剝離、妊娠併高血壓、早產、妊娠期的糖尿病、流產、妊娠期過小或過大嬰兒、羊水過少現象,產後出血以及死產等。
  
  調查學者辨識出有164名婦女於產後期間有過中風,於是研究人員將之與311名未中風婦女之年齡及生產日期進行比對;此項中風症狀之認定是依國際疾病分類標準第九版本(ICD-9)症狀編號430-439(而非非特定症狀437.3-437.7);中風症狀包括蛛網膜下出血、自發性腦出血以及缺血性中風。
  
  在這些中風過的婦女中,55%未有中風婦女中有73%為非裔美國人;Bushnell博士表示,這研究結果所顯示在人種上的差異,在未來應有進一步的研究。
  
  中風的發生平均在產後13.5年,而這些婦女平均年齡為40.1歲;懷孕時期患併發症婦女較之控制組病患(P = .0059),高出70%中風機率;於這些認定的併發症中, 只有妊娠併高血壓及妊娠期糖尿病與中風有關;併發症產生的機率分別為2.06倍及2.44倍。
  
  為說明由ICD-9症狀代號所辨識出的風險因素上的限制,研究調查學者下階段研究計畫是來比較這些婦女的醫療就診記錄。
  
  Bushnell博士指出,這項研究主要是讓我們了解妊娠併高血壓可能是內皮機能障礙,隨後中風風險以及心臟疾病的早期徵兆。

Certain Pregnancy Complication

By Paula Moyer, MA
Medscape Medical News

Sept. 29, 2005 (San Diego) — Certain complications during pregnancy put women at increased risk for stroke in later years, according to investigators who presented their findings here at the 130th annual meeting of the American Neurological Association.

Both preeclampsia and gestational diabetes were associated with an increased risk of stroke that was more than double that for women without such complications. Physicians should therefore counsel such women sooner rather than later to reduce their stroke risk factors, the investigators reported.

"Within this population of adverse pregnancy outcomes, there's probably a subset of women who are at extremely high risk who may be targeted for very early interventions," said presenting investigator Cheryl Bushnell, MD, MSc. Dr. Bushnell is an assistant professor of medicine at the Duke Center for Cerebrovascular Disease at Duke University Medical Center in Durham, North Carolina. However, exactly which women among those who have adverse outcomes should be targeted still needs to be determined, she said.

For now, physicians should monitor closely women who have had such outcomes and take extra efforts to help them reduce any other stroke risk factors, such as hypertension, elevated cholesterol, cigarette smoking, and dietary and exercise issues, Dr. Bushnell said.

The investigators conducted the study because prior research had shown that preeclampsia is associated with maternal cardiovascular disease later in life, but there are no definitive findings regarding stroke. Their case-control study used data from the Duke University Medical Center Perinatal and Health Services Outcomes Database. The database included all 42,263 women who had given birth between 1979 and 2005 at their facilities.

The complications that the researchers considered included abruption, preeclampsia, preterm birth, gestational diabetes, in utero fetal demise, small- and large-for-gestational-age size, oligohydramnios, postpartum hemorrhage, and stillbirth.

The investigators identified 164 women who had had a stroke after the postpartum period. The investigators then matched those women by age and the date of delivery to 311 women who had not had a stroke. The women who had had strokes were identified by International Classification of Diseases version 9 (ICD-9) codes 430 through 439 (other than the nonspecific codes 437.3 - 437.7). The stroke codes consisted of subarachnoid hemorrhage, spontaneous intracerebral hemorrhage, and ischemic stroke.

Of the women who had a stroke, 73% were African American compared with 55% of the women who did not have a stroke. Dr. Bushnell said that this ethnic disparity is a finding that should be explored in future studies.

Strokes occurred an average of 13.5 years after delivery, and the women were an average of 40.1 years old. The women who had had strokes were 70% more likely to have had a pregnancy complication than control patients (P = .0059). Among the complications considered, only preeclampsia and gestational diabetes were associated with stroke; these complications were associated with odds ratios of 2.06 and 2.44, respectively.

To address the limitations of identifying risk factors by ICD-9 codes, the investigators next plan to compare the codes to the women's medical records.

Dr. Bushnell said, "The main thing that this [study] does...is make us aware that preeclampsia is perhaps an early signal of endothelial dysfunction, a risk of stroke later in life, and heart disease."

ANA 130th Annual Meeting: Abstract 222. Presented September 27, 2005.

Reviewed by Gary D. Vogin, MD

    
相關報導
懷孕時期缺鐵和甲狀腺疾病有關
2016/8/10 下午 02:54:37
懷孕時甲狀腺功能低下是精神分裂症危險因素?
2016/7/20 下午 05:39:42
產前生活型態介入可以改善懷孕結果
2016/7/1 下午 04:37:03

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁