| Objectives:Through investigating serum lipid levels and perinatal outcomes in hypertensive disorder complicating pregnancy(HDCP),guide the early intervention of the disease and protect the health of maternity and infant.Methods:Data were derived from pregnant women who attended regular prenatal health care and delivered in Women’s Hospital,Zhejiang University School of Medicine from January 1st to December 31th,2014.The experimental group included 385 cases,while the control group consisted of 5771 cases.Inclusion criteria for both groups:singleton;excluding premature birth,stillbirth,IVF,malignant tumor,thyroid disease,diabetes,heart disease,psychosis and inherited meta’bolic diseases etc;no special drugs took that affect blood lipid metabolism,no hobbies such as smoking and drinking.Observed indexes include the general situation of pregnant women(age,progravid BMI,GWG,TG,TC,HDL,LDL),and perinatal outcomes(including LGA,SGA,cesarean section,premature birth,neonatal asphyxia,postpartum hemorrhage).The experimental group was divided into two subgroups according to the severity of HDCP.Data were tested by KS.Normally distributed continuous variables were presented as mean ± standard deviation(SD),and the t-test was used for comparison between groups.Non-normally distributed continuous variables were presented as median(interquartile range,IQR),and the comparison between groups was performed by rank sum test.Categorical variables were presented as N(%),and the chi-square test was used for comparison between groups.Risk analysis was performed by two-category unconditional logistic regression model.P values<0.05 were defined as statistically significant.Results:1.Age of the HDCP group(29.8±3.8 years)was significantly higher than that of the control group(28.6±3.1 years),p<0.05.The proportion of the proper age in the HDCP group(50.6%)was significantly lower than that in the control group(63.4%),and the ratio of pregnant women in advanced age(13.5%)was significantly higher than that in the control group(4.4%),p<0.05.2.Gestational times of the HDCP group(1.7±1.0)was significantly higher than that of the control group(1.6±0.9),p<0.05.Progravid BMI(22.4±3.5)in the HDCP group was significantly higher than that in the control group(20.3±2.6),p<0.05.The HDCP group had lower progravid low weight and normal weight ratio than the control group(9.4%vs 23.4%,63.1%vs 68.6%,respectively),while the ratio of overweight and obesity were significantly higher than that of the control group(20.8%vs 7.1%,6.7%vs 0.9%,respectively),p<0.05.3.GWG in the HDCP group(16.0±5.8Kg)was significantly higher than that in the control group(14.7±4.0Kg),p<0.05.The deficiency and appropriate ratios of GWG in the HDCP group were significantly lower than those in the control group(10.6%vs 19.9%,40,0%vs 53.8%,respectively),while the ratio of excessive GWG was significantly higher than that in the control group(49.4%vs 26.3%)5,p<0.05.4.The incidences of LGA,cesarean section and preterm birth in the HDCP group were significantly higher than those in the control group(6.8%vs 2.8%,59.2%vs 21.5%,11.4%vs2.2%,p<0.05 respectively).There were no significant differences in the incidences of SGA,postpartum hemorrhage rate,and neonatal asphyxia rate between the two groups.5.In the second trimester,TG level in the HDCP group was significantly higher than that in the control group[2.39(1.91,2.97)vs 1.98(1.59,2.45)nmol/L],and HDL level was significantly lower than that in the control group[2.19(1.94,2.55)vs 2,33(2.06,2.78)nmol/L].In the third trimester,TG level in the HDCP group was significantly higher than that in the control group[3.16(2.53,4.32)vs 2.91(2.27,3.78)nmol/L],and TC,HDL and LDL levels were significantly lower than those in the control group[6.22(5.36,7.23)vs 6.55(5.76,7.39),1.88(1.56,2.23)vs 2.07(1.77,2.38),3.37(2.72,4.17)vs 3.61(3.00,4.29)nmol/L,respectively],p<0.001.6.The incidences of cesarean section and preterm birth,the second-trimester TG level in the severe HDCP group were significantly higher than those in the mild HDCP group[90.6%vs 54.2%,34.0%vs 7.8%,2.70(2.29,3.14)vs 2.36(1.86,2.96)nmol/L,respectively],p<0.05.There were no significant differences in age,gestational times,multipara ratio,progravid BMI,GWG,LGA and SGA incidences,postpartum hemorrhage rate,neonatal asphyxia rate,and blood lipid levels in the third trimester.7.Binary logistic regression analysis showed that age(OR=1.089,95%CI 1.056-1.124),progravid BMI(OR=1.259,95%CI 1.215-1.306),GWG(OR=1.114,95%CI 1.088-1.142),mid-trimester TG(OR=1.421,95%CI 1.282-1.574)were positively correlated with the risk of HDCP;and TG level in mid-pregnancy(OR =1.302,95%CI 1.022-1.657)was a positive correlation factor of severe HDCP.8.Binary logistic regression analysis showed that age,progravid BMI,GWG,TC,TQ HDL and LDL levels were not associated with the risk of SGA in the HDCP group.In the control group,HDL level in the third trimester(OR=1.765,95%CI 1.403-2.220)was a positive correlation factor for SGA,and progravid BMI(OR=0.862,95%CI 0.824-0.902),GWG(OR=0.918,95%CI 0.893-0.943)were its negative correlation factors.9.Binary logistic regression analysis showed that TG level in the second trimester was a risk factor for preterm birth in both groups(OR=2.268,95%CI 1.144-4.494 in the HDCP group;OR=1.356,95%CI 1.003-1.835 in the control group),while GWG was a protective factor for preterm birth in both two groups(OR=0.922,95%CI 0.861-0.988 in the HDCP group;OR=0,913,95%CI 0.873-0.954 in the control group).Conclusion:1.HDCP should be reduced significantly by birth control among women of childbearing age.2.Controlling pre-pregnancy BMI and gestational weight gain is beneficial to reduce incidence and adverse perinatal outcomes of HDCP.3.TG level in the HDCP group was significantly higher than that in the control group in the second and third trimesters;HDL level was significantly lower than that in the control group.Meanwhile,the second-trimester TG was an important predictor of severe HDCP.It is suggested that blood lipids should be monitored closely during pregnancy,diet and lifestyle guidance should be given in time to reduce adverse perinatal outcomes. |
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