目的 分析孕母患不同类型妊娠期高血压疾病(HDP)对子代出生状况的影响,为改善其子代的预后提供科学依据。方法 回顾性选取2016年1月—2019年12月广州医科大学附属第三医院分娩的HDP产妇及其新生儿(n=1 004)作为研究对象,根据诊断分为妊娠期高血压(A组,n=256)、子痫前期-子痫(B组,n=577)、妊娠合并慢性高血压(C组,n=55)、慢性高血压并发子痫前期(D组,n=116),随机抽样获得正常对照组(n=1 107),比较子代出生情况差异。 结果 1)HDP组与对照组对比,胎儿窘迫、胎儿生长受限、胎盘早剥、早产儿、低出生体重儿、小于胎龄儿、新生儿窒息、转新生儿科或转院的发生率显著升高,差异有统计学意义(P＜0.05)。 2)胎儿生长受限、胎盘早剥和小于胎龄儿方面,B组发生率显著高于A组(P＜0.05)。 3)早产儿、极/超早产儿、低出生体重儿、极/超低出生体重儿、转新生儿科或转院的发生率,A、C、B、D组依次升高,两两比较,除A与C组外,其余任意两组间差异均有统计学意义(P＜0.05)。4)A组新生儿窒息发生率显著低于其余任意一组(P＜0.05)。结论 HDP中慢性高血压并发子痫前期引发更高的胎儿和新生儿不良结局风险,这可能与病程较长和病变较严重有关,提示孕期应尽早诊断和治疗,以改善子代预后。

Objective To explore the effects of different types of hypertensive disorders in pregnancy (HDP) on the birth conditions of their offspring, so as to provide scientific basis for improving the prognosis of their offspring.Methods A retrospective analysis was performed for the parturients with HDP and their newborns (n=1 004) who were born from January 2016 to December 2019 in the Third Affiliated Hospital of Guangzhou Medical University. Besides, they were divided into four types according to diagnosis, including gestational hypertension (group A, n=256), preeclampsia-eclampsia (group B, n=577), chronic hypertension(group C, n=55) and chronic hypertension with superimposed pre-eclampsia (group D, n=116). For comparison, 1 107 normal parturients and newborns were randomly selected into the control group. The birth conditions were compared between the two groups and among the four types of HDP.Results 1) Compared with the control group, the rates of fetal distress, fetal growth restriction, placental abruption, preterm, low birth weight, small for gestational age, neonatal asphyxia, transferring to neonatology department or other hospitals in the HDP group were significantly higher(P<0.05). 2) In terms of fetal growth restriction, placental abruption and small for gestational age, the prevalence rates in group B was significantly higher than those of group A (P<0.05). 3)The rates of preterm infants, very preterm infants, extremely preterm infants, low birth weight infants, very low birth weight infants, extremely low birth weight infants, transferring to neonatology department or other hospitals among group A, group C, group B, group D were increased in order. Pairwise comparison showed that, except for groups A and C, the differences between any two groups were statistically significant (P<0.05). 4) The prevalence rate of neonatal asphyxia in group A was significantly lower than that in any other groups (P<0.05).Conclusions Chronic hypertension with superimposed pre-eclampsia is associated with a higher risk of adverse fetal and neonatal outcomes, which could be caused by the longer course of the disease and more serious condition. It is suggested that early diagnosis and treatment of HDP should be carried out to improve the prognosis of their offsprings.