| [Objective]To investigate the risk factors of chronic hypertension complicated with preeclampsia and its influence on maternal and fetal pregnancy outcome,and to compare the improvement of adverse pregnancy outcomes and long-term prognosis by low-dose aspirin intervention[research methods]A total of 346 patients with singleton pregnancy who were hospitalized and delivered in the first Hospital of Jilin University from January 1,2011 to December 31,2021 were analyzed by retrospective cohort study.There were 137 cases of chronic hypertension complicated with pregnancy and 209 cases of chronic hypertension complicated with preeclampsia.Analyze and compare the incidence rate and incidence trend of preeclampsia in perinatal outcomes of pregnant women with a history of primary hypertension from January1,2011 to December 31,2021.The clinical data such as age,number of pregnancies and births,BMI before delivery,blood pressure level before pregnancy,previous history of preeclampsia and family history of hypertension were included.The data of two groups of chronic hypertensive pregnant women with preeclampsia and without preeclampsia were compared by t-test or x~2test,and the influencing factors related to the occurrence of slow and high preeclampsia were screened out,and the multivariate logistic regression analysis was further used,To explore and clarify the high risk factors of chronic preeclampsia.To analyze and compare the clinical test indexes and the incidence of maternal and fetal complications between chronic hypertension without preeclampsia and preeclampsia.The postpartum emotional changes and children’s quality of life（such as normal living ability,social role adaptability,etc.）of pregnant women with chronic hypertension and without preeclampsia were evaluated in the form of telephone follow-up and questionnaire,and the risk of poor long-term prognosis of mothers and infants was analyzed.In addition,76subjects from January 1,2020 to December 31,2021 were further divided into drug group（23 cases）and non drug group（53 cases）according to whether aspirin was used to prevent preeclampsia.The effects of drug intervention on pregnancy outcomes were compared.[research results]1.The incidence of chronic hypertension and preeclampsia:In recent 11 years,the incidence rate of preeclampsia in pregnant women with essential hypertension fluctuated between 31%and 79%.At the same time,with the implementation of China’s further comprehensive and in-depth reform of the second child policy in 2016,the incidence rate of pregnant women with chronic hypertension and preeclampsia has an increasing trend year by year.2.Analysis of main risk factors of chronic hypertension complicated with preeclampsia:the results of univariate analysis showed that there were statistically significant differences in blood pressure level before pregnancy（160/110mm Hg vs153/100mm Hg,P<0.05）and blood pressure had been systematically treated such as taking antihypertensive drugs or diet control regularly（12%vs35%,P<0.05）,while there were significant differences in age（P=0.120）,times of pregnancy and childbirth（P>0.05）,previous history of preeclampsia（P=1.00）and family history of hypertension（P=0.486）,There was no significant difference between the two groups（P>0.05）.The proportion of patients with BMI≥30 before delivery was significantly higher in the chronic hypertension with preeclampsia group（19.1%）than that in the non preeclampsia group（8.0%）,but there was no significant difference between the two groups（P>0.05）.Multivariate logistic analysis:blood pressure without systematic treatment and pre pregnancy diastolic pressure reaching or exceeding110mmhg were independent risk factors for the onset of preeclampsia,and the or（95%CI）were 7.137（2.911～17.496）and 4.382（1.451～13.230）respectively.3.Comprehensive impact of the occurrence of chronic hypertension with preeclampsia on maternal and infant pregnancy outcomes:the clinical test indexes of chronic hypertension without preeclampsia group and with preeclampsia group were compared and analyzed.The results showed that in all patients with chronic hypertension with preeclampsia,the indexes reflecting liver function,such as liver enzyme and LDH,were higher than those of non preeclampsia group.At the same time,compared with the group without preeclampsia,the level of serum creatinine（55.8umol/L vs 48.4umol/L,P<0.05）and serum uric acid（421.7±62.7mg/dl vs 317.8±38.1mg/dl,P<0.05）reflected the indexes of renal function.This result shows that the occurrence of preeclampsia will aggravate the damage to liver and kidney function to a certain extent.The comparison of the incidence of adverse pregnancy outcomes between the two groups showed that the incidence of HELLP syndrome（10.4%）and fetal distress（12.3%）in the group with concurrent preeclampsia were significantly higher than those in the group without concurrent preeclampsia（P<0.05）.There was no significant difference between the two groups in the rate of cesarean section,the risk of postpartum hemorrhage and the incidence of placental abruption.4.Effect of low-dose aspirin intervention on pregnancy outcome:aspirin intervention during pregnancy can not significantly reduce the high incidence rate of preeclampsia,but can effectively prolong the gestational weeks of delivery,reduce the incidence of preterm birth to a certain extent,and effectively improve the maternal and fetal outcomes.5.Long term prognosis evaluation:the postpartum blood pressure recovery and neonatal quality of life of all subjects were counted,and there was no significant difference after comparative analysis（P>0.05）.[research conclusion]1.The overall incidence rate of preeclampsia in pregnant women with a history of chronic hypertension was on the rise.2.Multivariate logistic analysis showed that no systematic antihypertensive treatment and pre pregnancy diastolic blood pressure exceeding 110mmhg were the independent risk factors for concurrent preeclampsia.3.The occurrence of preeclampsia in patients with chronic hypertensive pregnancy will aggravate the damage to liver and kidney function to a certain extent,and also increase the incidence rate of maternal HELLP syndrome and fetal distress.4.The use of low-dose aspirin during pregnancy does not significantly reduce the incidence of preeclampsia,but it has a certain effect on prolonging the gestational week of delivery,which can reduce the incidence of preterm birth and improve the prognosis of perinatal infants.5.The occurrence of chronic hypertension with preeclampsia did not significantly affect women’s postpartum mood and the quality of life of children（such as normal living ability,social role adaptability,etc.）. |
PDF Full Text Request