Mortality and Morbidity During Delivery Hospitalization Among Pregnant Women With Epilepsy in the United States.
Mortality and Morbidity During Delivery Hospitalization Among Pregnant Women With Epilepsy in the United States.
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DOI：
10.1001/jamaneurol.2015.1017
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发表时间：
2015-09
期刊：
影响因子：
29
通讯作者：
Hernández-Díaz S
中科院分区：
文献类型：
--
作者：
MacDonald SC;Bateman BT;McElrath TF;Hernández-Díaz S
在所有怀孕中，有0.3%至0.5%发生在癫痫妇女中。有证据表明癫痫妇女围产期发病率和死亡率增加。然而，这些风险尚未在大规模人群样本中进行量化。报告美国癫痫妇女分娩时的死亡风险和不良结局。对2007-2011年全国住院患者样本中通过分娩住院记录确定的孕妇进行的回顾性队列研究。从这20%的美国医院的代表性样本中，我们从69385名癫痫妇女和20449532名无癫痫妇女中获得了分娩住院的加权样本。产科结局包括孕产妇死亡、剖宫产、住院时间、先兆子痫、早产和死产。癫痫妇女在分娩住院期间的死亡风险为每10万例妊娠中有80例死亡，显著高于无癫痫妇女的每10万例妊娠中有6例死亡（校正比值比[OR]，11.46 [95%CI，8.64-15.19]）。患有癫痫的女性也有更高的风险发生其他不良后果，包括先兆子痫（调整OR，1.59 [95% CI，1.54-1.63]），早产（校正OR，1.54 [95% CI，1.50-1.57]）和死产（调整OR，1.27 [95%CI，1.17-1.38]），并增加了医疗保健利用，包括剖宫产风险增加在剖宫产妇女（调整后OR，2.13 [95%CI，2.03-2.23]）和阴道分娩妇女（调整后OR，2.60 [95%CI，2.41-2.80]）中，调整后OR，1.40 [95%CI，1.38-1.42]）和住院时间延长（>6天）。研究结果表明，患有癫痫的女性在分娩住院期间发生许多不良后果的风险大大增加，包括死亡风险增加10倍以上，并且增加临床关注对这些妊娠至关重要。
Between 0.3% and 0.5% of all pregnancies occur among women with epilepsy. Evidence suggests an increase in perinatal morbidity and mortality among women with epilepsy. However, these risks have not been quantified in large population-based samples. To report on the risk for death and adverse outcomes at the time of delivery for women with epilepsy in the United States. Retrospective cohort study of pregnant women identified through delivery hospitalization records from the 2007-2011 Nationwide Inpatient Sample. From this representative sample of 20% of all US hospitals, we obtained a weighted sample of delivery hospitalizations from 69 385 women with epilepsy and 20 449 532 women without epilepsy. Obstetrical outcomes including maternal death, cesarean delivery, length of stay, preeclampsia, preterm labor, and stillbirth. Women with epilepsy had a risk of death during delivery hospitalization of 80 deaths per 100 000 pregnancies, significantly higher than the 6 deaths per 100 000 pregnancies found among women without epilepsy (adjusted odds ratio [OR], 11.46 [95% CI, 8.64-15.19]). Women with epilepsy were also at a heightened risk for other adverse outcomes, including preeclampsia (adjusted OR, 1.59 [95% CI, 1.54-1.63]), preterm labor (adjusted OR, 1.54 [95% CI, 1.50-1.57]), and stillbirth (adjusted OR, 1.27 [95% CI, 1.17-1.38]), and had increased health care utilization, including an increased risk of cesarean delivery (adjusted OR, 1.40 [95% CI, 1.38-1.42]) and prolonged length of hospital stay (>6 days) among both women with cesarean deliveries (adjusted OR, 2.13 [95% CI, 2.03-2.23]) and women with vaginal deliveries (adjusted OR, 2.60 [95% CI, 2.41-2.80]). Findings suggest that women with epilepsy are at considerably heightened risk for many adverse outcomes during their delivery hospitalization, including a more than 10-fold increased risk of death, and that increased clinical attention is imperative for these pregnancies.