母亲妊娠高血压对子代儿童期血压影响的队列研究

背景：妊娠高血压不仅是孕妇围生期死亡的主要原因之一，而且可能会增加子代罹患心脑血管疾病的风险。目的：探讨妊娠高血压对子代儿童期血压的影响。设计：回顾性队列研究。方法：使用2014~2016年在重庆地区已建立的6~12岁儿童队列，根据基线调查时对队列人群进行的问卷调查，将母亲患有妊娠高血压的6~12岁儿童定义为暴露组，以1∶4比例匹配（性别、年龄和BMI）母亲无妊娠高血压的儿童为非暴露组。体格检查由经过统一培训的重庆医科大学附属儿童医院的护士完成，血压和心率测量工具为欧姆龙（HEM7051）上臂式电子血压计，血压同日重复测量3~5次，取3次最相近的计算平均值，若血压超出正常范围，2~4周后重新测量，2次血压值均符合高血压诊断标准判断为高血压，分年龄别、性别别与身高别的收缩压与舒张压分别取P90~＜P95为高血压前期，≥P95为高血压。主要结局指标：妊娠期高血压对子代儿童期高血压风险比值比（OR）。结果：共纳入1 630例儿童，平均年龄（9.1±1.7）岁，其中暴露组326例，非暴露组1 304例。暴露组收缩压［（105.1±10.0 ）vs（103.5±9.7 ）］mmHg、舒张压［（64.2±7.6 ）vs (63.2±7.9) mmHg］均高于非暴露组，差异有统计学意义；暴露组和非暴露组高血压前期+高血压患病率分别为28.5%和21.9%，差异有统计学意义（P=0.012），高血压的患病率分别为16.9%和12.9%，差异无统计学意义（P=0.061）。多因素Logistic回归分析显示，校正年龄、性别、家庭收入、母亲肥胖、母乳喂养、出生体重、现体重、心率和是否肥胖等因素后，与非暴露组相比，暴露组儿童患高血压的相对风险增加66%(OR=1.66，95%CI:1.13~2.43)。结论：母亲患有妊娠高血压会增加子代儿童期血压升高的风险。

Effects of gestational hypertension on blood pressure of offspring in childhood:A cohort study

Background: Gestational hypertension is not only one of the leading causes of perinatal death of pregnant women, but also might increase the risk of cardiovascular and cerebrovascular diseases in offspring. Objective: To investigate the effects of gestational hypertension on blood pressure of offspring in childhood. Design: Retrospective cohort study. Methods: The data of baseline survey conducted between 2014 and 2016 from a cohort study including children aged from 6 to 12 years in Chongqing were used. The exposure group was defined as those whose mother had gestational hypertension, and controls were randomly selected in a 1∶4 ratio from the children whose mother had normal blood pressure during pregnancy, matched with gender, age and BMI. Physical examination was performed by well-trained nurses from Children's Hospital of Chongqing Medical University. BP levels and heart rate were measured on three to five separate occasions with an OMRON arm-type electronic sphygmomanometer (HEM-7051). The average value of the closest three of the blood pressure measurements was used to represent resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) level. If the first blood pressure screening met the criteria of hypertension, the second measurement was conducted in the following 2~4 weeks. Children were diagnosed with hypertension if both two BP measurements met the criteria for hypertension. Prehypertension and hypertension was defined as mean clinic-measured SBP and/or DBP ≥P90 and ＜P95, and ≥P95 respectively, based on age, gender, and height percentiles. Main outcome measures: Odds ratio (OR) that estimating the effect of gestational hypertension on the risk of blood pressure of offspring in childhood. Results: A total of 1,630 children (exposure group: 326; control group: 1,306) with mean age of 9.10±1.73 years were included for statistical analysis. The systolic and diastolic blood pressures of children in the exposed group were significantly higher than that of control group (SBP: 105.1±10.0 mmHg vs 103.5±9.7 mmHg; DBP: 64.2±7.6mmHg vs 63.2±7.9mmHg). The proportion of prehypertension and hypertension (SBP≥P90or DBP≥P90) in exposure group was 28.5%, which was significantly higher than that of control group (21.9%, P=0.012). The prevalence of childhood hypertension in exposure group was higher than that of control group (16.9% vs 12.9%, P=0.061). After adjusted for age, gender, household income, obesity of mother, breast-feeding, birthweight, weight, heart rate, and obesity, gestational hypertension was an independent risk factor for childhood hypertension (OR=1.66, 95%CI: 1.13~2.43). Conclusion: Gestational hypertension of the mother is an independent risk factor for offspring's childhood hypertension.