Increased risk of severe maternal morbidity among infertile women: analysis of US claims data.
Increased risk of severe maternal morbidity among infertile women: analysis of US claims data.
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DOI：
10.1016/j.ajog.2020.02.027
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发表时间：
2020-09
影响因子：
9.8
通讯作者：
Eisenberg ML
中科院分区：
文献类型：
--
作者：
Murugappan G;Li S;Lathi RB;Baker VL;Luke B;Eisenberg ML
严重的产妇发病率仍然是国家和全球关注的一个问题，发病率正在增加。不孕不育的发病率也在上升，不孕妇女患慢性疾病和癌症的风险更高，这表明生育能力可能是了解妇女整体健康状况的一个窗口。目的探讨孕产妇生育状况对严重孕产妇发病的影响。2003-2015年使用Optum的去识别Clinformatics®数据集市数据库进行回顾性队列分析。通过不孕症诊断、检测或治疗分层的不孕妇女与寻求常规妇科护理的不孕妇女进行比较。在这两组中，只有在随访期间怀孕并分娩了单胎的妇女被包括在内。主要结局是由疾病预防控制中心定义的严重孕产妇发病率指标，并在每次分娩后6周内由ICD-10和CPT代码确定。结果调整了产妇年龄、种族、教育程度、无产、种族、吸烟、肥胖、分娩方式、早产、产前检查次数和分娩年份。19658名妇女组成不育组，525695名妇女组成可育组。在接受生育治疗的妇女中，任何严重孕产妇发病率指标的总体发生率为7.0%，在接受生育诊断的妇女中为6.4%，在接受生育检查的妇女中为5.5%，在有生育能力的妇女中为4.3%。总体而言，不孕妇女发生任何严重孕产妇发病指标的风险都明显更高（AOR 1.22, CI 1.14-1.31, p<0.01），弥散性血管内凝血（DIC） （AOR 1.48, CI 1.26 - 1.73, p<0.01），子痫（AOR 1.37, CI 1.05 - 1.79, p<0.01），手术或手术期间心力衰竭（AOR 1.54, CI 1.21 - 1.97, p<0.01），胸腔、腹部或骨盆内伤（AOR 1.59, CI 1.12 - 2.26, p<0.01）的风险也明显更高。与育龄妇女相比，颅内损伤（AOR 1.77, CI 1.20 ~ 2.61, p<0.01）、肺水肿（AOR 2.18, CI 1.54 ~ 3.10, p<0.01）、血栓栓塞（AOR 1.58, CI 1.14 ~ 2.17, p<0.01）、输血（AOR 1.50, CI 1.30 ~ 1.72, p<0.01）。与不育妇女相比，有生育能力的妇女在任何孕产妇发病率指标上的风险都没有明显增加。在母亲种族/民族的亚组分析中，与高加索妇女相比，生育能力强的黑人妇女与生育能力强的高加索妇女相比，严重孕产妇发病率的风险明显更高，而不育的黑人妇女与不育的高加索妇女之间的风险相似。使用保险索赔数据库，我们报告了被诊断为不孕症的妇女和接受生育治疗的妇女与有生育能力的妇女相比，患严重孕产妇疾病的多项指标的风险明显更高。有生育能力的黑人妇女与有生育能力的白人妇女相比，严重产妇发病率的风险增加，但不育的黑人妇女与不育的白人妇女面临相似的风险，这种风险在黑人妇女中有所降低。根据保险索赔数据，与有生育能力的妇女相比，不育妇女患严重孕产妇疾病的多种指标的风险要高得多。
Severe maternal morbidity continues to be an issue of national and global concern and is increasing in incidence. The incidence of infertility is also on the rise, and infertile women experience a higher risk of incident chronic medical disease and cancer, suggesting that fertility may serve as a window to a woman’s overall health. To investigate the risk of severe maternal morbidity by maternal fertility status. Retrospective cohort analysis using Optum’s de-identifed Clinformatics® Data Mart Database between 2003–2015. Infertile women stratified by infertility diagnosis, testing or treatment were compared to fertile women seeking routine gynecologic care. In both groups, only women who underwent pregnancy and delivery of a singleton during the follow up period were included. Main outcomes were severe maternal morbidity indicators, defined by the CDC, and identified by ICD-10 and CPT codes within 6 weeks of each delivery. Results were adjusted for maternal age, race, education, nulliparity, race, smoking, obesity, delivery mode, preterm birth, number of prenatal visits, and year of delivery. 19,658 women comprised the infertile group and 525,695 women comprised the fertile group. The overall incidence of any severe maternal morbidity indicator was 7.0% among women receiving fertility treatment, 6.4% among women receiving a fertility diagnosis, 5.5% among women receiving fertility testing and 4.3% among fertile women.. Overall, infertile women had a significantly higher risk of developing any severe maternal morbidity indicator (AOR 1.22, CI 1.14–1.31, p<0.01) as well as a significantly higher risk of disseminated intravascular coagulation (DIC) (AOR 1.48, CI 1.26 – 1.73, p<0.01), eclampsia (AOR 1.37, CI 1.05 – 1.79, p<0.01), heart failure during procedure or surgery (AOR 1.54, CI 1.21 – 1.97, p<0.01), internal injuries of the thorax, abdomen or pelvis (AOR 1.59, CI 1.12 – 2.26, p<0.01), intracranial injuries (AOR 1.77, CI 1.20– 2.61, p<0.01), pulmonary edema (AOR 2.18, CI 1.54 – 3.10, p<0.01), thrombotic embolism (AOR 1.58, CI 1.14 – 2.17, p<0.01), and blood transfusion (AOR 1.50, CI 1.30 – 1.72, p<0.01) compared to fertile women. Fertile women did not face a significantly higher risk of any maternal morbidity indicator compared to infertile women. In a subgroup analysis by maternal race/ethnicity, compared to Caucasian women, the risks of severe maternal morbidity were significantly higher for fertile Black women compared to fertile Caucasian women, while risks were similar between infertile Black women and infertile Caucasian women. Using an insurance claims database, we report that women diagnosed with infertility and women receiving fertility treatment experience a significantly higher risk of multiple indicators of severe maternal morbidity compared to fertile women. The increased risk of severe maternal morbidity noted among fertile Black women compared to fertile Caucasian women is attenuated among infertile Black women, who face similar risks as infertile Caucasian women. Infertile women face a significantly higher risk of multiple indicators of severe maternal morbidity compared to fertile women based on insurance claims data.
影响因子：
9.8
作者：
Murugappan G;Li S;Lathi RB;Baker VL;Luke B;Eisenberg ML
通讯作者：
Eisenberg ML