妊娠期高血压疾病患者泌乳开始和持续时间与血压恢复的关系。

摘要(中文译文)

妊娠期高血压疾病（HDPs）与长期母体心血管疾病风险增加有关。哺乳与良好的心脏代谢状况有关，但其对HDP后血压（BP）恢复的影响尚不清楚。我们试图评估先前患有HDP的个体的泌乳开始和持续时间与血压的关系。我们使用了前瞻性收集的数据，这些数据来自参加产后试点生活方式干预试验的孕前超重或肥胖的HDP患者，他们没有孕前高血压。父母试验在入组和随访（产后8-12个月）研究访视时，对BP进行了三次评估，并自我报告了哺乳状态。产后前6周通过家庭血压监测获得每日血压，产后第一年剩余时间每月监测1周。高血压被定义为血压≥130/80 mmHg或使用抗高血压药物。我们比较了哺乳开始时的人口统计学和心脏代谢结果，并创建了经年龄、种族、教育程度和孕前体重指数（BMI）调整的多变量逻辑回归模型，以评估哺乳与高血压的关系。129人的数据包括14177名家庭BP。总体而言，81%的参与者开始哺乳，哺乳期中位数为6个月[四分位数间距（IQR）2,9]。在随访时（产后10.9±2.1个月），与未开始哺乳的人相比，开始哺乳的个体的收缩压（SBP；p=0.004）和舒张压（DBP；p=0.008）均较低。在调整年龄、种族、教育程度和BMI后，每个月哺乳期与产后1年高血压发病率降低12%[调整后的比值比为0.88；95%置信区间（CI）为0.78-0.98]有关。在超重和肥胖的HDP患者中，哺乳期与1年后和整个产后第一年的收缩压和舒张压显著降低有关。https://clinicaltrials.gov/ct2/show/NCT03749746.

Abstract

Hypertensive disorders of pregnancy (HDPs) are associated with an increased risk of long-term maternal cardiovascular disease. Lactation is associated with favorable cardiometabolic profiles, but its impact on blood pressure (BP) recovery following an HDP is less clear. We sought to assess the relationship of lactation initiation and duration with BP among individuals with prior HDP. We used prospectively collected data from individuals with prepregnancy overweight or obesity with HDP and no prepregnancy hypertension who participated in a postpartum pilot lifestyle intervention trial. The parent trial assessed BP in triplicate and self-reported lactation status at enrollment and follow-up (8-12 months postpartum) study visits. Daily BPs were obtained by home BP monitoring for the first 6 weeks postpartum, then 1 week per month for the remainder of the first year postpartum. Hypertension was defined as BP ≥ 130/80 mmHg or the use of antihypertensive medications. We compared demographic and cardiometabolic outcomes by lactation initiation and created multivariable logistic regression models adjusted for age, race, education, and prepregnancy body mass index (BMI) to assess the relationship of lactation with hypertension. Data from 129 individuals included 14,177 home BPs. Overall, 81% of participants initiated lactation, and median lactation duration was 6 months [Interquartile range (IQR) 2,9]. At follow-up (10.9 ± 2.1 months postpartum), both systolic (SBP; = 0.004) and diastolic (DBP; = 0.008) BP were lower in individuals who initiated lactation compared with those who did not. Each month of lactation was associated with a 12% [adjusted odds ratio 0.88; 95% confidence interval (CI) 0.78-0.98] decreased odds of hypertension at 1 year postpartum with adjustment for age, race, education, and BMI. In overweight and obese individuals with an HDP, lactation is associated with a significant reduction in SBP and DBP at 1 year postpartum and throughout the first year postpartum. https://clinicaltrials.gov/ct2/show/NCT03749746.

如何引用