| PurposeHypertension is the Chinese people the onset of cardiovascular disease and the most important risk factor for death,and the rate of pregnancy combined with chronic hypertension will increase with the increasing prevalence of obesity and maternal age.Pregnancy women with chronic hypertension will increase the risk of adverse outcomes.Long-term hypertension can lead to adaptive changes in cardiac stress,often manifested by obvious changes in the geometry of the left ventricle,such as cardiac remodeling,concentric hypertrophy(CH).Left ventricular hypertrophy can predict poor cardiovascular prognosis as a risk factor for cardiovascular events.The geometric structure of the left ventricle is related to the prognosis.Studies have shown that for patients with centripetal hypertrophy,the quality of the left ventricle is the highest and the prognosis is the worst.Little is known about the impact of combined cardiac remodeling on chronic perinatal outcomes in patients with chronic hypertension.This study reviewed the cardiac indicators of chronic hypertensive patients in Qilu Hospital in the past decade and explored the effect of cardiocentric hypertrophy on chronic hypertension combined with pregnancy The impact of maternal and child outcomes of patients,and looking for the risk factors of maternal and child prognosis of patients with chronic hypertension,provide a new direction for the study of chronic hypertension combined with pregnancy.MethodCombined with the clinical data of pregnant women,162 cases of chronic hypertension were analyzed.According to the results of cardiac color Doppler ultrasound,there are two groups,centripetal hypertrophy group(65 cases)and anon-centripetal hypertrophy group(97 cases).We compare the mother complications and newborns of the two groups of patients.The prognosis of children,etc.,to explore the effect of centripetal hypertrophy on patients with chronic hypertension.And,according to the clinical characteristics of patients,through single factor and multi-factor logistic regression analysis,to find the high-risk factors of maternal and neonatal adverse outcomes in patients with chronic hypertension and pregnancy,establish a model and use the ROC curve to evaluate the ability to predict of the model.Result There were 162 patients with chronic hypertension in this study,65 in the centripetal hypertrophy group and 97 in the non-central hypertrophy group.The median age of all patients was 35 years,of which the median age in the CH group was 34 years,and non-CH The median age of the group was 36 years old,the median pregnancy times of the CH group and the non-CH group were 3 times the same,and the median parity of the CH group and the non-CH group were 1 time.There were 57(58.8%)cases in the non-CH group Routine use of antihypertensive drugs,28(43.1%)patients in the CH group were routinely treated with antihypertensive drugs,4(6.2%)patients in the CH group received assisted reproductive technology,and 4(4.1%)patients in the non-CH group Assisted reproductive technology conceived.There were 3(4.6%)twin pregnancies in the CH group,and 1(1.0%)twin pregnancies in the non-CH group.A total of 48 patients had adverse complications in all patients,including 26 cases(40%)in the CH group and 22(22.7%)cases in the non-CH group.There were 137 neonates and 98(71.7)cases had neonatal complications.There were 42 cases(87.5%)in the CH group and 56 cases(62.9%)in the non-CH group.The probability of pre-eclampsia in CH group was significantly higher than that in non-CH group(75.4%vs 56.7%),the difference was statistically significant(P=0.002),The rate of adverse pregnancy outcomes in the CH group was much greater than that in the non-CH group(40.0%vs 22.7%),and the difference was statistically significant(P=0.023).The probability of therapeutic induction of labor in the CH group was much higher than that in the non-CH group(29.2%vs 10.3%),the difference was statistically significant(P=0.007).The probability of adverse complications of neonates in the CH group was obviously more than that in the non-CH group(87.5%vs 62.9%),the difference was statistically significant(P=0.003),and the preterm birth rate in the CH group was apparently more than that in the non-CH group(83.3%vs 58.4%),the difference was statistically significant(P=0.004),the rate of combined SGA of newborns in CH group was also obviously more than that in non-CH group((18.8%vs 4.5%),the difference was statistically significant(P=0.012).The NICU occupancy rate of newborns in CH group was obviously more than that in non-CH group(79.2%vs 52.8%),the difference was statistically significant(P=0.002).The median weight of newborns in CH group was much smaller than that in non-CH group Group(1850g vs 2400g),the difference was statistically significant(P=0.022).In the single factor analysis of maternal adverse complications,we found that they include:no use of antihypertensive drugs(p=0.018),combined with preeclampsia(p<0.001),LVEF(p=0.003),LVM(p=0.063),LVMI(p=0.015),severe hypertension(<0.001),CH(p=0.019),urinary protein(p=0.001),LDH(p=0.001),PLT(<0.001)are chronic hypertension combined with pregnancy Potential risk factors for adverse outcomes of patients;multiple logistic regression analysis showed that:LDH≥231U/L,combined with severe hypertension are independent risk factors for mothers with adverse outcomes in patients with chronic hypertension and pregnancyIn the single factor analysis of neonatal adverse complications,we found that:mothers with preeclampsia(p<0.001),LVM(p=0.010),LVMI(p=0.001),CH(p=0.004),mothers with severe complications Hypertension(p<0.001),urine protein(p<0.001),ALT(p=0.004),AST(p=0.015),LDH(p<0.001),CR(p=0.001),BUN(p<0.001),PLT(p<0.001)is a potential risk factor for adverse neonatal outcomes;and multiple logistic regression analysis shows that:mothers with severe hypertension,CH,and urine protein levels are independent risk factors for chronic hypertension with pregnant women with adverse outcomes.Conclusion1.Chronic hypertension pregnant women with CH have a higher incidence of pre-eclampsia.2.The combined CH chronic hypertension in pregnant women,the probability of occurrence of adverse maternal complications rises3.Mother with severe hypertension and LDH ≥ 231U/L are independent risk factors for adverse complications of the mother.4.CH,Proteinuria and mothers with severe hypertension are independent risk factor for adverse neonatal complications. |
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