The Analysis Of Related Factors And Maternal And Fetal Outcomes Of Hypertensive Disorder Of Pregnancy

BackgroundHypertensive disorder of pregnancy is a group of diseases coexisting with pregnancy and elevated blood pressure,with an incidence of 5%-12%.It not only threatens maternal-fetal health,but also leads to serious maternal-fetal outcomes.At present,HDP is the third leading cause of maternal death following postpartum hemorrhage and amniotic fluid embolism in our country.There are many factors related to HDP,involving social,psychological,and medical aspects.Exploring related factors of HDP,and then identifying the risk factors,providing useful data for clinically strengthening maternal management of HDP.The prediction has a certain role in early prevention of high-risk pregnant women and reducing adverse maternal and infant outcomes associated with HDP.ObjectiveRetrospective analysis of clinical data of 172 HDP pregnant women and 172normal pregnant women,to explore the risk factors of HDP and maternal and fetal outcomes,and learn more about the pathogenesis of HDP,aim to early prediction and prevention of HDP and improve the prognosis of the disease for pregnant women and perinatal infants.MethodsThis study used a retrospective analysis method to collect the pregnant women with single births who had a perinatal profile,regular birth check-ups,and labored at the First Affiliated Hospital of Guangzhou Medical University from January 2016 to August 2019,197 pregnant women with HDP were screened out,as chronic hypertension with pregnancy and chronic hypertension complicated with pre-eclampsia belong to the special type of HDP,25 cases of chronic hypertension with pregnant women were discarded.Therefore,the remaining 172 cases were selected as the case group.1221 healthy pregnant women who gave birth in the same period were selected,and 172 cases were selected as the control group according to the random number table method.From the first,second and third trimesters of pregnancy,the general conditions,blood biochemical indicators and maternal and infant outcomes of the two groups were compared.At the same time,the above conditions were compared from three subgroup levels of hypertension during pregnancy(group A),preeclampsia(group B),and severe preeclampsia(group C).Firstly,univariate analysis was performed.The quantitative data comparison between the two groups were performed using independent sample t test and Mann-Whitney U test,qualitative data using 2×2 chi-square test.Quantitative data comparison between multiple groups were performed using one-way ANOVA or Kruskal-Wallis H test,and qualitative data was used 2×C chi-square test.Factors that differed in the univariate analysis were included in the regression analysis.Case group and control group used binary logistic regression analysis method,and group A,B,and C used ordinal logistic regression analysis method to analyze the risk factors about HDP and its severity.Results1.Results of univariate analysis of HDP and control group:The proportion of elderly women with a family history of hypertension in the case group was higher than that in the control group(p<0.05).In the first trimester,the white blood cells,neutrophils,Hct,platelets and NLR of pregnant women in case group were higher than those in control group(p<0.05).In the second trimester,the white blood cells,neutrophils,NLR,PLR,Hct,fibrinogen,and ALT of pregnant women in case group were higher than those in control group(p<0.05).In the third trimester,the case group had higher white blood cells,neutrophils,NLR,MPV,Hct,fibrinogen,ALT,TBA,and prenatal BMI than the control group(p<0.05),and lymphocytes,platelets,APTT,TT were lower than those in the control group(p<0.05).2.Binary logistic regression analysis of HDP:Advanced maternal age,family history of hypertension,and primiparity are risk factors for HDP.High levels of neutrophils and Hct in the first trimester,high levels of Hct,fibrinogen,and ALT the second trimester,high levels of fibrinogen,ALT,TBA,prenatal BMI and low levels of TT and albumin in the third trimester,are the risk factors for HDP.3.Univariate analysis of HDP severity:There were no statistically significant differences between groups A,B,and C in advanced maternal age,family history,education,pregnancy way,abortion history,and parity(p>0.05).In the first trimester,there were statistically significant differences in leukocytes,neutrophils,and Hct among pregnant women in groups A,B,and C(p<0.05).In the second trimester,there were statistically significant differences in Hct and PLR among pregnant women in groups A,B,and C(p<0.05).In the third trimester,There were statistically significant differences in leukocytes,neutrophils,NLR,PLR,PT,fibrinogen,APTT,TT,albumin,and TBA among pregnant women in groups A,B,and C(p<0.05).4.Ordinal logistic regression analysis of HDP severity:High levels of neutrophils and Hct in the first trimester,high levels of peripheral blood Hct in the second trimester,and low levels of PT,APTT,TT and albumin in the third trimester are risk factors that affect the severity of HDP.5.ROC curve of risk factors for HDP in the first trimester:Neutrophil,AUC=0.612,95%CI:0.553?0.671,p<0.05.The optimal threshold for neutrophil count is 8.45×10~9/L.Hct,AUC=0.598,95%CI:0.538?0.658,p<0.05.The optimal threshold for Hct is 36.5%.Conclusion1.HDP is a group of multi-factors related diseases.The occurrence and development of HDP is a chronic process.The risk factors for the onset of HDP and the severity of the disease are different at different trimester of pregnancy.2.Advanced maternal age,primipara,and family history of hypertension are risk factors for HDP?3.Through analyzing the blood biochemical of HDP pregnant women,the pathogenesis of HDP is verified and expanded.4.Peripheral blood neutrophils and Hct in in the first trimester have a certain predictive effect on the incidence of HDP.5.HDP increase the incidence of adverse maternal and infant outcomes such as preterm birth,fetal growth restriction,and cesarean section,but dose not increase the incidence of postpartum hemorrhage and neonatal asphyxia.