Trends in Maternal Morbidity Before and During Pregnancy in California
Trends in Maternal Morbidity Before and During Pregnancy in California
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DOI：
10.2105/ajph.2013.301583
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发表时间：
2014-02-01
影响因子：
12.7
通讯作者：
Gregory, Kimberly D.
中科院分区：
文献类型：
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作者：
Fridman, Moshe;Korst, Lisa M.;Gregory, Kimberly D.
目标.我们研究了加利福尼亚州母亲合并症的趋势。我们使用1999年、2002年和2005年与州相关的生命统计数据和出院队列数据，对1551017名加州出生的婴儿进行了回顾性队列研究。我们使用国际疾病分类第九次修订版临床修改代码来识别以下疾病，其中一些是预先存在的：孕产妇高血压，糖尿病，哮喘，甲状腺疾病，肥胖，精神健康状况，药物滥用和烟草使用。我们用分层逻辑回归模型估计患病率，调整人口统计学变化，并检查种族/民族的相似性。这些合并症的患病率随着时间的推移而增加，这表明孕妇的病情越来越严重。种族/族裔差异也很大。2005年，非西班牙裔黑人母亲分娩的婴儿中有10%以上受到产妇高血压的影响;亚裔/太平洋岛民母亲分娩的婴儿中有近10%受到产妇糖尿病的影响（自1999年以来分别增加了10%和43%）。慢性高血压、糖尿病、肥胖、精神健康状况和烟草使用在美洲土著妇女中表现出最大的增长。在加州，孕妇妊娠前和妊娠期间合并症的患病率大幅上升，并显示出独立于人口统计学变化的种族/民族差异。
Objectives. We examined trends in maternal comorbidities in California.Methods. We conducted a retrospective cohort study of 1 551 017 California births using state-linked vital statistics and hospital discharge cohort data for 1999, 2002, and 2005. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify the following conditions, some of which were preexisting: maternal hypertension, diabetes, asthma, thyroid disorders, obesity, mental health conditions, substance abuse, and tobacco use. We estimated prevalence rates with hierarchical logistic regression models, adjusting for demographic shifts, and also examined racial/ethnic disparities.Results. The prevalence of these comorbidities increased over time for hospital admissions associated with childbirth, suggesting that pregnant women are getting sicker. Racial/ethnic disparities were also significant. In 2005, maternal hypertension affected more than 10% of all births to non-Hispanic Black mothers; maternal diabetes affected nearly 10% of births to Asian/Pacific Islander mothers (10% and 43% increases, respectively, since 1999). Chronic hypertension, diabetes, obesity, mental health conditions, and tobacco use among Native American women showed the largest increases.Conclusions. The prevalence of maternal comorbidities before and during pregnancy has risen substantially in California and demonstrates racial/ethnic disparity independent of demographic shifts.