Pregnancy Outcomes in Women with Spinal Cord Injuries: A Population-Based Study
Pregnancy Outcomes in Women with Spinal Cord Injuries: A Population-Based Study
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DOI：
10.1002/pmrj.12122
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发表时间：
2019-08-01
期刊：
影响因子：
2.1
通讯作者：
Mueller, Beth A.
中科院分区：
文献类型：
--
作者：
Crane, Deborah A.;Doody, David R.;Mueller, Beth A.
背景：先天性或获得性脊髓损伤的孕妇由于神经功能和活动能力受损而面临挑战，这些因素也可能影响胎儿/婴儿的健康。很少有研究调查了这一人群的妊娠过程和长期结果。目的：利用基于人群的数据评估脊髓损伤、瘫痪或脊柱裂妇女的妊娠结局。设计：回顾性队列研究。背景：华盛顿州出生医院出院记录。参与者：1987-2012年，所有患有脊髓损伤、瘫痪或脊柱裂的单胎活产女性（N = 529），以及一组无残疾的女性（N = 5282）。方法：诊断代码筛选，以确定病例和10:1随机抽样比较妇女。使用多变量回归对每种情况分别计算总体和95%置信区间（ci）。随后的住院或死亡是通过与分娩后2年的出院/死亡记录联系来确定的。主要结局测量：妊娠过程（体重增加、妊娠糖尿病、子痫前期、感染、静脉血栓栓塞）、分娩/分娩特征、婴儿特征（出生体重/大小、胎龄）和长期结局（产妇/婴儿再次住院的发生/原因、死亡率）。结果：患有这些脊柱疾病的妇女产前尿路感染/肾盂肾炎（RR 26.43, 95% CI 13.97-49.99）、静脉血栓栓塞（RR 9.16, 95% CI 2.17-38.60）、胎膜早破（RR 2.15, 95% CI 1.18-3.90）和剖宫产（RR 1.88, 95% CI 1.70-2.09）的调整后风险增加。包括产后抑郁症（RR 8.15, 4.29-15.48）或外伤（RR 13.05, 95% CI 6.60-25.81），她们的住院时间更长，再住院率增加（RR 1.54, 95% CI 1.28-1.87）。他们的婴儿通常比胎龄小（RR 1.65, 95% CI 1.33-2.06），但再次住院或死亡的风险没有增加。结论：我们观察到患有这些疾病的女性婴儿的长期发病率没有增加。产后头几年可能增加的产妇发病率表明需要干预的领域。
Background: Pregnant women with congenital or acquired spinal cord injury face challenges due to compromised neurologic function and mobility, factors that may also affect fetal/infant health. Few studies have examined pregnancy course and longer-term out-comes in this population.Objective: To assess pregnancy outcomes among women with spinal cord injury, paralysis, or spina bifida using population-based data.Design: Retrospective cohort study.Setting: Washington state linked birth-hospital discharge records.Participants: All women (N = 529) with spinal cord injury, paralysis, or spina bifida with singleton live birth deliveries 1987-2012, and a comparison group of women without disabilities (N = 5282).Methods: Diagnosis codes were screened to identify cases and a 10:1 random sample of comparison women. Relative risks (RRs) and 95% confidence intervals (Cis) were calculated overall and separately for each condition using multivariable regression. Subsequent hospitalizations or death were identified via linkage to hospital discharge/death records for 2 years after delivery.Main Outcome Measurements: Pregnancy course (weight gain, gestational diabetes, preeclampsia, infection, venous thromboembolism), delivery/labor characteristics, infant characteristics (birthweight/size, gestational age), and longer-term outcomes (occurrence/reasons for maternal/infant rehospitalization, mortality).Results: Women with these spinal conditions had increased adjusted risks of prenatal urinary tract infection/pyelonephritis (RR 26.43, 95% CI 13.97-49.99), venous thromboembolism (RR 9.16, 95% CI 2.17-38.60), preterm rupture of membranes (RR 2.15, 95% CI 1.18-3.90), and cesarean delivery (RR 1.88, 95% CI 1.70-2.09). They had longer hospitalizations and increased rehospitalization (RR 1.54, 95% CI 1.28-1.87), including for postpartum depression (RR 8.15, 4.29-15.48) or injury (RR 13.05, 95% CI 6.60-25.81). Their infants were more often small for gestational age (RR 1.65, 95% CI 1.33-2.06), but had no increased risk of rehospitalization or death.Conclusions: We observed no increased long-term morbidity among infants of women with these conditions. Possible increased maternal morbidities during the first postpartum years indicate areas for intervention.