Sickle Cell Disease in Pregnancy: Maternal Complications in a Medicaid-Enrolled Population
Sickle Cell Disease in Pregnancy: Maternal Complications in a Medicaid-Enrolled Population
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DOI：
10.1007/s10995-012-1216-3
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发表时间：
2013-02-01
影响因子：
2.3
通讯作者：
Hooper, W. Craig
中科院分区：
文献类型：
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作者：
Boulet, Sheree L.;Okoroh, Ekwutosi M.;Hooper, W. Craig
据报道，镰状细胞病（SCD）妇女的妊娠并发症发生率高于无SCD妇女;然而，过去的研究受到样本量小、地理区域狭窄和使用出院数据的限制。我们在一个大的、地理上不同的样本中比较了患有SCD和没有SCD的分娩期和产后妇女的母体并发症的患病率。来自2004-2010年Truven Health MarketScan（A（R））多州医疗补助数据库的数据被用于评估15-44岁患有和不患有SCD的分娩期和产后妇女的孕产妇并发症患病率，这些妇女的种族被报告为黑人。没有SCD的女性对照组进一步分为与多器官衰竭相关的慢性疾病和没有慢性疾病的女性。多变量对数二项回归模型用于计算SCD女性与两个对照组女性相比的结果的校正患病率。在2004-2010年期间分娩的335，348名黑人妇女中，有1，526名被诊断为SCD（0.5%）。与患有慢性疾病的非SCD女性相比，患有SCD的女性有更高的深静脉血栓形成、肺栓塞、产科休克、肺炎、败血症、产后感染和输血的患病率。与无SCD和慢性疾病的女性相比，SCD与急性肾衰竭、脑血管疾病、呼吸窘迫综合征、子痫、产后出血、早产和通气呈正相关。总的来说，患有SCD的女性妊娠并发症的患病率增加，即使与一组具有相似多器官衰竭风险的女性相比。
Higher frequencies of pregnancy complications have been reported among women with sickle cell disease (SCD) compared with those without SCD; however, past studies are limited by small sample size, narrow geographic area, and use of hospital discharge data. We compared the prevalence of maternal complications among intrapartum and postpartum women with SCD to those without SCD in a large, geographically diverse sample. Data from the 2004-2010 Truven Health MarketScan(A (R)) Multi-State Medicaid databases were used to assess the prevalence of maternal complications among intrapartum and postpartum women 15-44 years of age with and without SCD whose race was reported as black. The comparison group of women without SCD was further divided into those with chronic conditions associated with multi-organ failure and those without chronic conditions. Multivariable log-binomial regression models were used to calculate adjusted prevalence ratios for outcomes for women with SCD compared with women in the two comparison groups. Of the 335,348 black women with a delivery during 2004-2010, 1,526 had a diagnosis of SCD (0.5 %). Compared with women without SCD who had chronic conditions, women with SCD had higher prevalence of deep vein thrombosis, pulmonary embolism, obstetric shock, pneumonia, sepsis, postpartum infection, and transfusions. SCD was also positively associated with acute renal failure, cerebrovascular disorder, respiratory distress syndrome, eclampsia, postpartum hemorrhage, preterm birth, and ventilation when compared with women without SCD and chronic conditions. Overall, women with SCD have increased prevalence of pregnancy complications, even when compared with a group of women with similar risk for multi-organ failure.