Association of alcohol and other substance-related diagnoses with severe maternal morbidity.
Association of alcohol and other substance-related diagnoses with severe maternal morbidity.
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酒精和其他物质相关诊断与严重孕产妇发病率的关系。
DOI：
10.1111/acer.14671
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Marienfeld CB
中科院分区：
文献类型：
--
作者：
Courchesne NS;Smith LR;Zúñiga ML;Chambers CD;Reed MB;Ballas J;Marienfeld CB
被诊断患有与药物有关的疾病（如酒精使用障碍）的孕妇是一个脆弱人群，与未被诊断患有与药物有关的疾病的孕妇相比，其严重孕产妇发病率（如出血和子痫）可能更高。这项回顾性横断面研究回顾了2016年3月1日至2019年8月30日期间在妊娠≥ 20周时分娩单胎活产或死胎的女性（年龄18-44岁）的电子健康记录数据。有和没有物质相关诊断的妇女在关键人口统计学特征（如年龄）上以1：1的比例匹配。调整这些协变量，计算比值比和95%置信区间。共有10，125例分娩符合本研究的合格标准。在1,346例分娩的匹配队列中，673例（50.0%）有物质相关诊断，94例（7.0%）有严重的孕产妇发病率。与药物相关诊断的女性中最常见的指标包括子宫切除术（17.7%）、子痫（15.8%）、空气和血栓栓塞（11.1%）和心律转换（11.1%）。具有物质相关的诊断与严重的孕产妇发病率相关（校正的比值比= 1.81 [95%CI，1.14-2.88]，p值= 0.0126）。在按物质类型独立匹配的队列中，酒精相关的诊断与严重的孕产妇发病率显著相关（校正比值比= 3.07 [95% CI，1.58-5.95]，p值= 0.0009），虽然兴奋剂和尼古丁相关诊断的模式在严重的孕产妇发病率和阿片类药物和大麻中没有得到很好的解决，相关诊断与严重的孕产妇发病率无关。我们发现，酒精相关的诊断，虽然在物质相关的诊断患病率最低，有最高的几率严重孕产妇发病率的任何物质相关的诊断评估在这项研究中。这些发现加强了早期识别孕妇酒精相关诊断的必要性，以通过干预和治疗将潜在危害降至最低。
Pregnant women with a substance-related diagnosis, such as an alcohol use disorder, are a vulnerable population that may experience higher rates of severe maternal morbidity, such as hemorrhage and eclampsia, than pregnant women with no substance-related diagnosis. This retrospective cross-sectional study reviewed electronic health record data on women (aged 18–44 years) who delivered a single live birth or stillbirth at ≥ 20 weeks of gestation from March 1, 2016, to August 30, 2019. Women with and without a substance-related diagnosis were matched on key demographic characteristics, such as age, at a 1:1 ratio. Adjusting for these covariates, odds ratios and 95% confidence intervals were calculated. A total of 10,125 deliveries met the eligibility criteria for this study. In the matched cohort of 1,346 deliveries, 673 (50.0%) had a substance-related diagnosis, and 94 (7.0%) had severe maternal morbidity. The most common indicators in women with a substance-related diagnosis included hysterectomy (17.7%), eclampsia (15.8%), air and thrombotic embolism (11.1%), and conversion of cardiac rhythm (11.1%). Having a substance-related diagnosis was associated with severe maternal morbidity (adjusted odds ratio = 1.81 [95% CI, 1.14–2.88], p-value = 0.0126). In the independent matched cohorts by substance type, an alcohol-related diagnosis was significantly associated with severe maternal morbidity (adjusted odds ratio = 3.07 [95% CI, 1.58–5.95], p-value = 0.0009), while the patterns for stimulant- and nicotine-related diagnoses were not as well resolved with severe maternal morbidity and opioid- and cannabis-related diagnoses were not associated with severe maternal morbidity. We found that an alcohol-related diagnosis, although lowest in prevalence of the substance-related diagnoses, had the highest odds of severe maternal morbidity of any substance-related diagnosis assessed in this study. These findings reinforce the need to identify alcohol-related diagnoses in pregnant women early to minimize potential harm through intervention and treatment.
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