Factors Of Hypertensive Disorders Of Pregnancy And Adverse Perinatal Pregnancy Outcome In Secondary Pregnancy Women

Background and Purpose:Hypertensive disorders of pregnancy(HDP)is one of the risk factors for adverse maternal outcomes,and is also closely related to the occurrence of long-term postpartum cardiovascular events.With the gradual opening of fertility policy,the number of elderly pregnant women in China has increased in recent years,resulting in a significant upward trend in the incidence of HDP and the proportion of high-risk pregnant women.We aim to explore the factors related to HDP and adverse perinatal pregnancy outcomes in secondary pregnancy women.In order to provide better pre-pregnancy guidance for women who plan to give birth to a second child.Method:1.From January 1,2016 to December 31,2020,pregnant women with HDP who delivered a second child in the Obstetrics Department of the Third Xiangya Hospital of Central South University were selected as the research subjects,and those with severe cardiac and renal insufficiency,assisted reproductive technology and severe loss of records were excluded.With age as the matching factor,according to the ratio of case group:control group=1:2,women without HDP who delivered a second child in hospital at the same time were randomly selected as the control group.The general information,physical examination data,laboratory indicators,information of the first pregnancy,and previous comorbid diseases were collected in the case group and control group through the medical record system.T test,chi-square and nonparametric test were used to compare the differences between two groups,and the possible influencing factors were incorporated into the logistic regression model to explore the risk factors related to HDP in secondary pregnancy women.2.Among the secondary pregnancy women with HDP,the occurrence of adverse perinatal pregnancy outcome was inquired through the medical record system,and they were divided into groups with adverse pregnancy outcomes and those without adverse pregnancy outcomes.The clinical data of the two groups were collected,and the t-test,chi-square and nonparametric test were used to compare the differences.The possible influencing factors were incorporated into the logistic regression model to explore the risk factors of adverse perinatal pregnancy outcomes in secondary pregnancy women with HDP.Result:1.A total of 301 secondary pregnancy women with HDP were enrolled in the case group,and 602 cases were matched in the control group.In the case group,the proportion of elderly pregnant women(age>35 years)was about 41.2%,23.58%of pregnant women had a long pregnancy interval(>10 years),58.13%of pregnant women were overweight(BMI>28kg/m2),and 10.63%of pregnant women have HDP in their first pregnancy,which recurs in their second pregnancy.Compared with the control group,the proportion of BMI>28kg/m~2(57.81%vs 34.67%,P=0.000),pregnancy interval>10 years(23.59%vs16.94%,P=0.020),first-pregnancy pregnant women with HDP(10.63%vs 1.16%,P=0.000)are higher in case group.There were differences in the delivery mode and gender composition of the first fetus between the two groups.Cesarean section was the main delivery mode in the case group,while vaginal delivery was the main delivery mode in the control group(P<0.05).The sex of the first fetus in the case group was more female(P<0.05).Multivariate regression analysis showed that BMI>28kg/m~2(OR=2.557,95%CI:1.903-3.437,P=0.000),pregnancy interval>10 years(OR=1.455,95%CI:1.013-2.089,P=0.042)and HDP in the first pregnancy(OR=10.971,95%CI:4.684-25.694,P=0.000)may be risk factors of HDP in the secondary pregnancy women.Gerder of male of the first fetus seems to reduce the possibility of HDP in the secondary pregnancy(OR=0.436,95%CI:0.265-0.791,P=0.001).2.In 301 secondary pregnancy women complicated with HDP,46.18%of them had adverse pregnancy outcomes in perinatal period.Compared with pregnant women without adverse pregnancy outcomes,these patients had higher systolic blood pressure(149.16±21.88 vs139.86±15.41,P=0.000),slower heart rate(88.01±13.07 vs 92.20±11.82,P=0.004),higher creatinine(62.63±35.30 vs 51.46±8.96,P=0.000),lower platelet count(182.56±56.82 vs 202.92±67.11,P=0.005),higher fasting blood glucose(4.64±1.29 vs 4.18±0.75,P=0.000),longer pregnancy interval between two fetuses(8 vs 6,P=0.021),and higher proportion of positive proteinuria(58.27%vs 27.16%,P=0.000).Multivariate regression analysis showed increased creatinine level(OR=1.033,95%CI:1.004-1.063,P=0.023),fasting blood glucose level(OR=1.485,95%CI:1.060-2.007,P=0.020)and positive proteinuria(OR=3.385,95%CI:1.765-6.494,P=0.000)may be risk factors for adverse perinatal pregnancy outcomes in secondary pregnancy women with HDP.Conclusion:1.Overweight,long pregnancy interval and HDP in the first pregnancy may be risk factors for secondary pregnancy women with HDP.2.For secondary pregnancy women with HDP,creatinine level,fasting blood glucose and proteinuria may be risk factors for adverse perinatal pregnancy outcomes.