慢性高血压及其合并妊娠期糖尿病的患病率和妊娠结局

颜雪梅; 肖霞; 孔繁娟; 陈立章

doi:10.11817/j.issn.1672-7347.2024.230596

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论著 | 更新时间：2024-07-03

慢性高血压及其合并妊娠期糖尿病的患病率和妊娠结局
Prevalence and outcome of chronic hypertension and its complications with gestational diabetes
中南大学学报(医学版) 中南大学学报(医学版) 2024年49卷第3期页码：400-407
作者机构：

1.湖南省妇幼保健院内科,长沙 410008
2.湖南省妇幼保健院病案管理科,长沙 410008
3.中南大学湘雅公共卫生学院,长沙 410013
4.临床流行病学湖南省重点实验室,长沙 410013
作者简介：

颜雪梅，Email: 510883700@qq.com, ORCID: 0000-0003-2620-4186
陈立章，Email: chenliz@csu.edu.cn, ORCID: 0000-0001-5426-0519
基金信息：

国家自然科学基金(81973137);湖南省科技厅项目(2018SK2062);湖南省妇幼保健院项目(2021RX26┫。This work was supported by the National Natural Science Foundation ┣81973137);the Project of Hunan Provincial Maternal and Child Health Care Hospital(2021RX26)
DOI：10.11817/j.issn.1672-7347.2024.230596
中图分类号：
CSTR：
纸质出版日期： 2024-03-28 ，

收稿日期： 2023-12-27 ，
稿件说明：

颜雪梅, 肖霞, 孔繁娟, 陈立章. 慢性高血压及其合并妊娠期糖尿病的患病率和妊娠结局[J]. 中南大学学报(医学版), 2024, 49(3): 400-407.

YAN Xuemei, XIAO Xia, KONG Fanjuan, CHEN Lizhang. Prevalence and outcome of chronic hypertension and its complications with gestational diabetes[J]. Journal of Central South University. Medical Science, 2024, 49(3): 400-407.
颜雪梅, 肖霞, 孔繁娟, 陈立章. 慢性高血压及其合并妊娠期糖尿病的患病率和妊娠结局[J]. 中南大学学报(医学版), 2024, 49(3): 400-407. DOI：10.11817/j.issn.1672-7347.2024.230596

YAN Xuemei, XIAO Xia, KONG Fanjuan, CHEN Lizhang. Prevalence and outcome of chronic hypertension and its complications with gestational diabetes[J]. Journal of Central South University. Medical Science, 2024, 49(3): 400-407. DOI：10.11817/j.issn.1672-7347.2024.230596

摘要

目的

随着中国生育政策全面放开、女性妊娠年龄逐步提高、育龄期超重和肥胖比例逐步增加，慢性高血压(chronic hypertension，CHTN)合并妊娠期糖尿病(gestational diabetes mellitus，GDM)的孕妇比例呈现增多趋势，发生不良妊娠结局风险显著增加。本研究拟分析CHTN及其合并GDM的患病率，并比较二者的不良妊娠结局，旨在为制订干预措施提供依据。

方法

本研究为前瞻性研究。根据2016年1月1日至2020年12月31日期间共378 366例大型孕妇队列，筛选出CHTN孕妇1 418例，其中单纯CHTN 1 027例，CHTN合并GDM 391例。应用SAS9.4统计分析孕妇的基本情况、临床资料和妊娠结局，并分析影响CHTN及其合并GDM患者妊娠结局的危险因素。

结果

妊娠合并CHTN的患病率为3.8‰，CHTN合并GDM的患病率为1.0‰。CHTN合并GDM患者占所有CHTN孕妇总数的27.57%(391/1 418)。母亲年龄，妊娠次数，产次，既往剖宫产次数，入队列时收缩压、舒张压和平均动脉压在CHTN合并GDM与单纯CHTN 2组间的差异均有统计学意义(均

0.05)。在调整孕妇年龄、妊娠次数、产次等可能的混杂因素后，二元Logistic回归分析结果显示：CHTN合并GDM孕妇发生剖宫产的危险是CHTN孕妇的1.348倍(

=1.348，95%

1.043~1.741)，发生胎盘粘连的危险是CHTN孕妇的2.029倍(

=2.029，95%

1.190~3.462)，发生子痫前期的危险是CHTN孕妇的1.540倍(

=1.540，95%

1.101~2.152)，结局为巨大儿的危险是CHTN孕妇的2.670倍(

=2.670，95%

1.398~5.100)。

结论

CHTN孕妇合并GDM的风险较高，CHTN合并GDM患者的妊娠结局与仅患有CHTN的孕妇在剖宫产、胎盘粘连、子痫前期及巨大儿发生方面存在差异。CHTN合并GDM患者的孕期保健，特别是其血压及血糖的管理更需要重点关注。

Abstract

Objective

With the full liberalization of China’s fertility policy

the gradual increase in maternal age during pregnancy

and the rising proportion of overweight and obesity among women of childbearing age

the number of pregnant women with chronic hypertension (CHTN) combined with gestational diabetes mellitus (GDM) is increasing

leading to a significantly increased risk of adverse pregnancy outcomes. This study aims to analyze the prevalence of CHTN and CHTN complications with GDM

and compare the adverse pregnancy outcomes between the 2 conditions

providing a basis for intervention measures.

Methods

This study was a prospective cohort study. A total of 378 366 cases from a large cohort of pregnant women between January 1

2016 to December 31

2020 were screened to identify 1 418 cases of pregnant women with CHTN

among which 1 027 were cases of CHTN alone and 391 were cases of CHTN combined with GDM. SAS9.4 was used to statistically analyze the basic characteristics

clinical data

and pregnant outcomes of pregnant women and to analyze the risk factors affecting the pregnancy outcomes of patients with CHTN and its complications with GDM.

Results

The prevalence rate of CHTN with pregnancy was 3.8‰

and the prevalence rate of CHTN combined with GDM was 1.0‰. Patients with CHTN combined with GDM accounted for 27.57% (391/1 418) of all pregnant women with CHTN. Maternal age

number of pregnancies

parity

previous cesarean section

systolic blood pressure

diastolic blood pressure

and mean arterial pressure at the time of enrollment were statistically significant differences between the 2 groups (all

0.05). After adjusting for potential confounding factors such as maternal age

parity

and number of pregnancies

binary Logistic regression analysis showed that pregnant women with CHTN combined with GDM had a 1.348 times higher risk of cesarean section (

=1.348

95%

1.043 to 1.741)

a 2.029 times higher risk of placental adhesion (

=2.029

95%

1.190 to 3.462)

a 1.540 times higher risk of preeclampsia (

=1.540

95%

1.101 to 2.152)

and a 2.670 times higher risk of macrosomia (

=2.670

95%

1.398 to 5.100) compared to pregnant women with CHTN alone.

Conclusion

Pregnant women with CHTN combined with GDM have a high risk

and their pregnancy outcomes differ from those of pregnant women with CHTN alone in terms of cesarean section

placental adhesion

preeclampsia

and macrosomia. Prenatal care for this population

especially the management of blood pressure and blood sugar

needs to be given special attention.

关键词

慢性高血压妊娠期糖尿病妊娠结局前瞻性队列研究

Keywords

chronic hypertensiongestational diabetes mellituspregnancy outcomeprospective cohort study

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