[西班牙妇产科学会和西班牙血管预防跨学科委员会的共识文件。机会之窗:预防妇女的血管风险。不良妊娠结果和血管疾病风险。]

Revista espanola de salud publica Pub Date : 2023-10-11
María Goya, Marta Miserachs, Anna Suy Franch, Jorge Burgos, María de la Calle, Carlos Brotons, Mar Castellanos, Olga Cortés Rico, Ángel Díaz Rodriguez, Roberto Elosúa, María Del Mar Freijo, María González Fondado, Manuel Gorostidi, María Grau, Antonio M Hernández Martínez, Carlos Lahoz, Nuria Muñoz-Rivas, Vicente Pallares-Carratalá, Juan Pedro-Botet, Enrique Rodilla, Enrique Goya, Miguel Ángel Royo Bordonada, Rafael Santamaría, Mónica Torres Fonseca, Aina Velescu, Alberto Zamora, Pedro Armario
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摘要

本文件总结了不良妊娠结局(APOs)之间的相关性证据,如高血压疾病、早产、妊娠期糖尿病、胎儿生长缺陷(胎龄小和/或胎儿生长受限)、胎盘早剥、胎儿丢失,以及孕妇患上可能导致未来血管疾病(VD)的血管危险因素(VR)的风险:冠心病、中风、外周血管疾病和心力衰竭。此外,本文件强调了在评估女性VR时识别APO的重要性。APOs病史可作为VD一级预防的充分指标。事实上,在患有APOs的女性中,从怀孕和/或产后开始,采用健康的饮食和增加体育活动,并在一生中保持健康,是可以减少VR的重要干预措施。另一方面,母乳喂养也可以降低女性未来的VR,包括降低死亡率。未来对有APOs史的女性使用阿司匹林、他汀类药物和二甲双胍等进行评估的研究可能会加强对这些患者VD一级预防药物治疗的建议。存在各种医疗保健系统选项,以改善不同医疗保健专业人员之间对患有APO的女性的护理过渡,并实施长期VR减少策略。一个潜在的过程可能涉及将妊娠晚期的概念纳入临床建议和医疗保健政策。
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[Documento de consenso de la Sociedad Española de Obstetricia y Ginecologia (SEGO) y el Comité Español Interdisciplinario para la Prevención Vascular (CEIPV). Ventana de oportunidad: prevención del riesgo vascular en la mujer. Resultados adversos del embarazo y riesgo de enfermedad vascular.]

This document summarises the evidence regarding the association between adverse pregnancy outcomes (APOs), such as hypertensive disorders, preterm birth, gestational diabetes, fetal growth defects (small for gestational age and/or fetal growth restriction), placental abruption, fetal loss, and the risk that a pregnant individual in developing vascular risk factors (VR) that may lead to future vascular disease (VD): coronary heart disease, stroke, peripheral vascular disease, and heart failure. Furthermore, this document emphasises the importance of recognising APOs when assessing VR in women. A history of APOs serves as a sufficient indicator for primary prevention of VD. In fact, adopting a healthy diet and increasing physical activity among women with APOs, starting during pregnancy and/or postpartum, and maintaining it throughout life are significant interventions that can reduce VR. On the other hand, breastfeeding can also reduce the future VR of women, including a lower risk of mortality. Future studies evaluating the use of aspirin, statins, and metformin, among others, in women with a history of APOs could strengthen recommendations regarding pharmacotherapy for primary prevention of VD in these patients. Various healthcare system options exist to improve the transition of care for women with APOs between different healthcare professionals and implement long-term VR reduction strategies. One potential process could involve incorporating the fourth-trimester concept into clinical recommendations and healthcare policies.

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