Long-term Prognosis Of Women With Preeclampsia And Risks Of Incidence In Their Female Offspring

BackgroundPreeclampsia(PE)is the disorder of pregnancy characterized by the onset of hypertension,proteinuria and other symptoms which begins 20 weeks after pregnancy of a woman of normotension.PE is a idiopathic disease which originates from placenta with the incidence of 5%to 8%[1].PE often causes the dysfunction of multiple organs,including:abnormal liver and renal function,blood system disorder,heart failure,pulmonary edema,fetal growth restriction,intrauterine death,etc.It is one of the major diseases that has a serious impact on the health of mother and fetus,and one of the major death factors for maternal and fetal death[2].So far there is no effective treatment for PE except pregnancy termination.The pathogenesis of PE has long been the focus for perinatal medicine,though not clearly demonstrated,poor trophoblastic invasion leading to shallow placental implantation has been the widely-acknowledged as the early pathological basis for PE,which leads to placenta ischemia,hypoxia,vascular anomaly and inflammatory response during the second and third trimester,and then the onset of PE[3],Previous study showed that with the delivery of the placenta,the symptoms of PE patients can relive and disappear gradually.But currently some statements showed that PE patients have high risks of hypertension,myocardial ischemia,and stroke in the next 10 to 15 years after delivery.And their offspring also have higher risks of hypertension during their young and adult age[4].This study worked on the long-term prognosis of PE and its impact on offsprings of these patients.This study worked on the risks of incidence for long-term cardiovascular,brain,renal diseases and other complications for the PE patients and also the risks of PE for their offspring.It aimed to provide suggestive opinion on the prevention and control for PE,reduce the risks of serious complications of PE patients and improve the prognosis for them.ObjectiveThe study has examined the long-term prognosis of preeclampsia patients and the risks of preeclampsia of their offspring during pregnancy.It compared the risks of long-term hypertension,diabetes and cardiovascular,brain and renal diseases of preeclampsia patients,and also the incidence of preeclampsia of their offspring during pregnancy.It aims to reduce the risks of serious complications for preeclampsia patients,improve the long-term prognosis and improve their livelihood.MethodsFrom January 2015 to June 2017,311 patients aged between 45 to 65 in Physical Examination Department of Linyi People's Hospital,Physical Examination Center of Qilu Hospital of Shandong University and Physical Examination of Jinan Maternal and Child Care Hospital were recruited as a study group,and 328 women with normal delivery were recruited as a control group.Gestational age of the two groups was 28 to 42 weeks,and their last delivery was at least ten years ago.Medical records and physical examination reports in the last three months of the participants in the study were examined and those without these records were given a physical examination on-site.Both groups had no history of cardiovascular disease,diabetes and other medical complications.The information collected include:? basic information,including age,height,body mass,delivery hospital;? previous delivery:including both previous delivery and total times of delivery,body mass changes during pregnancy,blood pressure,edema,proteinuria,gestational age and the body mass of new-born;? family history.The family history of hypertension,diabetes,chronicle kidney disease,earl-onset cardiovascular and brain disease of immediate family members(biological parents,children and siblings with the same parents,male under 55 years old and female under 65 years old).Criteria:if any one of the patient's parents or siblings had history of the above mentioned disease,the information was collected.? pregnancy inspection and pregnancy outcome of the daughters of patients.Results1)General situation in the two groups.In the observation group,the average age was(57.48 + 8.32)years old,the average body mass index was(23.92 + 5.03)Kg/m2 and the average interval between delivery to survey was(22.33 + 8.61)years.In the control group,the average age was(58.57 + 6.7)years,and the average body mass index was(24.83 + 2.93)Kg/m2,and the average interval between delivery to survey was(24 + 7.07)years.There was no statistical significance of the differences between the two groups in terms of age,BMI,and interval between delivery to survey(P>0.05).2)Family history in the two groups.There was no statistical significance(P>0.05)for the difference of history of diabetes(P=0.26)and chronical kidney disease(P=0.71)for the two groups.But the hypertension history of the study group(P<0.001)and the history of cardiovascular and brain disease(P=0.006)are evidently higher than the control group which means statistical significance(P<0.05).3)Childbearing history in the two groups.In the study group,there were 956 times of pregnancies,563 times of deliveries,390 times of miscarriages and 521 times of survivals;in the control group,there were 987 times of pregnancies,574 times of deliveries,413 times of miscarriages and 562 times of survivals.There is no statistical significance of the differences(?2=0.55,P=0.91).In the study group,there were 557 times of singleton delivery,3 times of twin delivery and 1 time of triplet delivery,and 35 times of induction of labor or caesarian section caused by serious preeclampsia or placental abruption,and 10 cases of stillbirth or dead fetus caused by premature delivery and other reasons.In control group,there were 12 cases stillbirth or dead fetus caused by premature delivery or other reasons.There were 554 times of singleton deliveries,4 times of twin delivery.There is no statistical significance of the differences of the times of deliveries of the two groups(?2=1.79,P=0.41).4)Incidence of preeclampsia in the study group.In the study group,there are 563 times of deliveries with a gestational age between 28 to 42 weeks and 360 incidences of preeclampsia during pregnancy.Specifically speaking,?there are 94 cases where women had preeclampsia and then had subsequent deliveries.Recurrence of preeclampsia were found in 42 cases(incidence of preeclampsia in both deliveries were found in 36 cases,incidence of preeclampsia in all three deliveries were found 4 cases,incidence of preeclampsia in all four times of deliveries were found in 2 cases),with a recurrence rate of 44.68%.There were 13 cases where women had gestational hypertension in their second pregnancy but with relieved symptoms,accounting for 41.19%for the total.There were 39 cases where patients had normal blood pressure in their second pregnancy,with a recovery rate of 41.49%;? there were 58 cases where women had gestational hypertension during pregnancy and also had subsequent deliveries.In 24 cases,women had preeclampsia during their second pregnancy,accounting for 41.38%of the total.In 34 cases,women had normal blood pressure in their second pregnancy,accounting for 58.62%of the total.?there are 192 cases where women only had preeclampsia once(including one delivery or preeclampsia during the last pregnancy).And there is no way to verify the reoccurrence rate for these patients.5)Remote outcome in the two groups.In the study group,the morbidity rate of long-term hypertension(P<0.001),diabetes(P=0.023),microalbuminuria(P<0.001),end-stage renal disease(P=0.046),heart failure(P=0.361),stroke(P=0.039)are all higher than the control group and the difference of the remote outcome of the two group has statistical significance(P<0.05=6)The incidence of preeclampsia in the daughters of the patients in both groups.In the study group,there were total of 521 children including 289 daughters.There were 97 cases where the daughters had at least one child;in the control group,there were total of 562 children including 270 daughters.And There were 104 cases where the daughters had at least one child.The daughters in the study group has higher risks of preeclampsia during pregnancy than the daughters in the study group(OR:5.35;95%CI:2.20?12.97).The incidence of preeclampsia is evidently higher than the control group(27.84%vs 6.73%),which has a statistical significance(?2=15.91,P<0.01)Conclusions1)Patients with preeclampsia are more likely to suffer from hypertension,diabetes,cardiovascular disease(CVD),cerebrovascular disease and chronical kidney disease.2)The incidence of preeclampsia,especially severe preeclampsia,increases in the offspring of women with preeclampsia.3)Family history of hypertension and early onset cardiovascular disease and cerebrovascular is a risk factor for preeclampsia which can be a warning sign for the risks of preeclampsia in the next generation.4)History of preeclampsia and gestational hypertension is a high-risk factor for the recurrences of preeclampsia.5)Gestation period is an important opportunity for the prevention and control of preeclampsia.For patients with family and personal history of preeclampsia,it is suggested to establish a systematic pregnancy inspection profile and conduct regular inspection.Effective precautious measures should be actively taken.6)For preeclampsia patients,secondary prevention of CVD and CKD should be taken immediately after delivery and re-examination and assessment should be done on a yearly basis.It is also suggested to take more measures in improving lifestyle and improve the prognosis of the preeclampsia patients.