Preeclaimpsia And Subsequent Cardiometabolic Risk And The Related Factors

Objective:To estimate the prevalence of Cardiovascular Metabolism Risks for women whoexperienced preeclampsia and investigate the association of metabolic factors withCardiovascularmetabolisc Risk,aiming at providing a window for prevention andblocking.Methods:1.344newly diagnosed preeclamptic women (PE group) and1180controls (NC group) that had been enrolled in our study.All of them were in the thirdtrimester of a singleton pregnancy and were recruited from the pregnant women presenting for perinatal health care at the department of Obstetrics ofthe Guangdong Women and Children’s Hospital and Health Institute between June2009and August2011.2. We measured admission systolic blood pressure（A-SBP）and admission diastolic blood pressure（A-DBP）,then we collected peripheral blood samples of all the studied subjects as soon as the diagnoses were make sure,we alsodetect admission fasting blood glucose(A-FBG),Admission fasting insulin(A-FINS),Admission total cholesterol(A-TCH),Admission triglycerides(A-TG),Admission low density lipoprotein cholesterol(A-LDL-C) and Admission high density lipoprotein cholesterol(A-HDL-C). Further more,we calculate Admissionhomeostatic model assessment of insulin resistance(A-HOMA-IR)and Admis sion body mass index(A-BMI), we also collect characteristics of all the studied subjects,including age,height,weight and parity,measured Base systolic blood pressure (B-SBP),Base diastolic blood pressure (B-DBP) and Base body mass index(B-BMI).After that,we compared outcomes of pregnancy in PEgroup with NC group and then used one-Way ANOVA to compared all the factors above in PE group with NC group.3. We measured Postpartum systolic blood pressure (P-SBP),Postpartum diastolic blood pressure(P-DBP),collected peripheral blood samples of all the studied subjectsin order to detect Postpartum fasting blood glucose(P-FBG),Postpartum fasting insulin(P-FINS),Postpartum total cholesterol(P-TCH),Postpartum triglycerides(P-TG),Postpartum low density lipoprotein cholesterol(P-LDL-C)and Postpartum high density lipoprotein cholesterol(P-HDL-C),and test OGTT-2h.Further more,wecalculated Postpartum homeostatic model assessmentof insulin resistance(P-HOMA-IR)and Postpartum body mass index(P-BMI),then we used one-Way ANOVA tocompared all the factors above in PE group with NC group.4. Estimate the prevalence of Cardiovascular Metabolism Risk which includedhypertension,abnormal glucose metabolism,dyslipidemia,overweight and fat and Metabolic syndrome for women who experienced preeclampsia and NCgroup,and investigated the association of factors with postpartum Cardiovascular Metabolism Risk.Results:1. Compared to women in NC group,women in PE group appear significantlyhigher B-BMI[(21.99±3.21vs.20.56±2.59)kg/m2，P=0.005]；significantly higher B-SBP[(122.52±14.91vs.105.30±6.88)mmHg，P<0.001]，significantly higher B-DBP[(75.24±9.53vs.66.15±5.60)mmHg，P<0.001]；significantlyhigher FBG[(4.52±0.72vs4.17±0.30)mmol/L，P=0.002]；significantly highe r A-HOMA-IR[(2.67±1.11vs1.71±1.10)mmol~2/L~2，P=0.021]；significantly higher A-TG(3.47±1.44vs2.74±1.16)mmol/L，P=0.049]；significantly lower A-HDL-C[(1.09±0.39vs1.56±0.33)mmol/L，P=0.031].2. The proportion of premature birth,low birth weight,small for gestational agechildren,neonatal asphyxia of women in PE group are higher than women in NC group,in detail were（45.06%vs.7.97%，P＜0.001）、（47.09%vs.4.41%，P＜0.001）、（23.55%vs.8.56%，P＜0.001）、（11.63%vs.5.84%，P＜0.001）.The risks are （RR5.66，95%CI:4.51-7.09）、（RR10.69，95%CI:8.01-14.26）、（RR2.75，95%CI:2.11-3.59）、（RR1.99，95%CI:1.37-2.88）.3. Compared to women in NC group,women in PE group appear significantlyhigher P-SBP[(121.46±17.66vs.105.67±10.55)mmHg，P<0.001]，significantly higher P-DBP[(80.91±13.74vs.68.90±8.32)mmHg，P<0.001]；significantly higher P-TG[(1.17±0.68vs.0.84±0.46)mmol/L，P=0.001]；significantly low P-HDL-C [(0.98±0.49vs.1.34±0.24)mmol/L，P＜0.001]；significantly higher P-FBG[(5.27±0.89vs.5.04±0.31)mmol/L，P=0.048]；significantly higher P-HOMA-IR[(2.14±1.34vs1.67±0.77)mmol/L，P=0.015].4. Compared to women in NC group,PE group is hight proportion of hypertension,abnormal glucose metabolism,dyslipidemia,overweight and fat and metabolic syndrome:（25.58%vs1.16%，P＜0.001）、（32.85%vs23.31%，P＜0.001）、（48.84%vs23.14%，P＜0.001）and（11.63%vs1.69%，P＜0.001.5. The potential risk factors of postpartum hypertension were:B-SBP,B-BMI,A-TG and A-AG.The adjusted ORs were1.21(95%CI:1.10-1.44，P=0.035),1.06(95%CI:1.02-1.11，P=0.004),2.11(95%CI:1.01-4.48，P=0.041) and1.14(95%CI:1.02-1.29，P=0.027).The potential risk factors of postpartum abnormal glucose metabolism were B-BMI,A-HOMA-IR and A-HDL-C.The adjusted ORswere1.21(95%CI:1.06-1.39，P=0.005)、1.94(95%CI:1.01-3.86，P=0.037) and0.21(95%CI:0.06-0.74，P=0.015).The potential risk factors of postpartum dyslipidemia were:B-BMI,A-AG and A-HOMA-IR.The adjusted ORs were1.1 4(95%CI:1.01-1.29，P=0.030),1.08(95%CI:1.01-1.17，P=0.041) and1.40(95%CI:1.06-3.33，P=0.031).The potential risk factors of overweight and fat wasB-BMI and A-HOMA-IR.The adjusted ORs were1.94(95%CI:1.442-2.598，P＜0.001) and1.69(95%CI:1.14-3.42，P=0.028).The potential risk factors ofpostpartum metabolic syndrome was B-SBP,A-AG and A-TG.The adjusted ORs were1.03(95%CI:1.01-1.06，p=0.005),1.13(95%CI:1.04-1.24，P=0.006) and1.21(95%CI:1.04-1.41，p=0.013).Conclusion:1. There are significantly metabolic abnormalities in women in PE group as compared to women in NC group.2. The proportion of premature birth,low birth weight,small for gestational agechildren,and neonatal asphyxia were significantly higher in the women inPE group as compared to women in NC group,which suggestes that preeclampsia has anegative imact on pregnancy outcomes.3. There is significantly postputum metabolic abnormalities in women in PE group as compared to NC group.4. Compared to women in NC group,the proportion of cardiovascularmetabolicrisk,such as hypertension,abnormal glucose metabolism,dyslipidemia,overweight and fat and metabolic syndrome, is higher than women in NC group.5. The potential risk factors of postpartum cardiovascularmetabolic risk is B-BMI、A-AG、B-SBP、A-TG、A-HDL-C and A-HOMA-IR.In detail B-SBP、B-BMI、A-TG and A-AG are independent potential risk factors of hypertension,B-BMI、A-HOMA-IR and A-HDL-C are independent potential risk factors of abnormal glucose metabolism,B-BMI、A-AG and A-HOMA-IR are independent potential risk factors of dyslipidemia,B-BMI and A-HOMA-IR are independent potential risk factors of overweight and fat,B-SBP、A-AG and A-TG are independent potential risk factors of metabolic syndrome.