​​产科出血和30年后心血管疾病风险：一项基于人群的队列研究

【目的】

研究产科出血和产后30年罹患心血管疾病的关系

【设计】

基于人群的队列研究。

【处所和人群】

加拿大魁北克地区1989年至2016年间所有分娩的妇女。

【方法】

利用住院数据，直至2018年3月共1224975名妇女在第一次分娩后被随访。主要暴露因素为产前出血（前置胎盘、胎盘早剥、围产期出血）或产后出血，伴或不伴输血。采用校正Cox回归模型分析产科出血和远期心血管疾病的相关性。

【主要测量结局】

需住院的心血管疾病。

【结果】

在104291（8.5%）名产科出血的妇女中，4621（4.4%）需要输血。存在产科出血的妇女发生需要住院的心血管疾病率较无出血的妇女升高（15.5 vs 14.1/10000人年数；2437 vs28432事件）。相较于无产科出血的妇女，伴或不伴输血的产科出血妇女罹患需住院的心血管疾病风险增加（校正危险比aHR 1.06, 95%CI 1.02-1.10）。伴有输血的产科出血患者罹患需住院的心血管疾病风险更高（aHR 1.47, 95% CI 1.23–1.76）。在伴有输血的妇女中，胎盘早剥（aHR 1.79, 95% CI 1.06–3.00）和产后出血（aHR 1.38, 95% CI 1.13–1.68）均与需住院的心血管疾病风险相关。伴输血的产前出血妇女罹患需住院的心血管疾病的5年风险增加2.46倍（95% CI 1.59–3.80），10年风险增加2.14倍（95% CI 1.47–3.12）。

【结论】

需要输血的产科出血与母体心血管疾病存在相关性。预防产科出血妇女心血管疾病风险的益处需要进一步研究。

Obstetric haemorrhage and risk of cardiovascular disease after threedecades: a population‐based cohort study

UVUkah  RWPlatt  BJPotter  GParadis  NDayan  SHe  NAuger

First published: 16 May 2020                

https://doi.org/10.1111/1471-0528.16321

【Objective】

To investigate the association betweenobstetric haemorrhage and cardiovascular disease up to three decades afterpregnancy.

【Design】

Population‐based cohort study.

【Setting and population】

All women who delivered between 1989 and2016 in Quebec, Canada.

【Methods】

Using hospital admissions data,1 224 975 women were followed from their first delivery until March2018. The main exposure measures were antenatal (placenta praevia, placentalabruption, peripartum haemorrhage) or postpartum haemorrhage, with or withouttransfusion. Adjusted Cox regression models were used to assess the associationbetween obstetric haemorrhage and future cardiovascular disease.

【Main outcome measure】

Cardiovascular hospitalisation.

【Results】

Among 104 291 (8.5%) women with haemorrhage,4612 (4.4%) required transfusion. Women with haemorrhage had a higher incidenceof cardiovascular hospitalisation than women without haemorrhage (15.5 versus14.1 per 10 000 person‐years; 2437 versus 28 432 events). Risk ofcardiovascular hospitalisation was higher for obstetric haemorrhage, with orwithout transfusion, compared with no haemorrhage (adjusted hazard ratio [aHR]1.06, 95% CI 1.02–1.10). Women with haemorrhage and transfusion had asubstantially greater risk of cardiovascular hospitalisation (aHR 1.47, 95% CI1.23–1.76). Among transfused women, placental abruption (aHR 1.79, 95% CI1.06–3.00) and postpartum haemorrhage (aHR 1.38, 95% CI 1.13–1.68) were bothassociated with risk of cardiovascular hospitalisation. Antenatal haemorrhagewith transfusion was associated with 2.46 times the risk of cardiovascular hospitalisationat 5 years (95% CI 1.59–3.80) and 2.14 times the risk at 10 years(95% CI 1.47–3.12).

【Conclusions】

Obstetric haemorrhage requiring transfusionis associated with maternal cardiovascular disease. The benefit ofcardiovascular risk prevention in pregnant women with obstetric haemorrhagerequires further investigation.

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   （编译 王伟琳）​​​​​