Maternal Morbidity Associated With Early-Onset and Late-Onset Preeclampsia
Maternal Morbidity Associated With Early-Onset and Late-Onset Preeclampsia
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DOI：
10.1097/aog.0000000000000472
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发表时间：
2014-10-01
影响因子：
7.2
通讯作者：
Joseph, K. S.
中科院分区：
文献类型：
--
作者：
Lisonkova, Sarka;Sabr, Yasser;Joseph, K. S.
目的：研究早发性与晚发性先兆子痫及相关严重孕产妇发病率的时间趋势。方法：本研究包括2000年至2008年华盛顿州所有单胎分娩（n= 670，120）。先兆子痫的发病是通过与出生证明相关的医院记录来确定的。重度孕产妇发病率定义为任何可能危及生命的疾病。采用Logistic回归分析获得校正的比值比（aOR）和95%置信区间（95%CI）。结果：子痫前期的发病率为每100例单胎分娩3.0例，2000年至2008年略有增加，从2.9增加到3.1。早发性和迟发性疾病的发生率分别为0.3%和2.7%。调整母体特征变化后，仅早发性疾病的时间增加显著（4.5%/年; 95%CI 2.3-5.8%）。早发型（42.1/100，000分娩）和晚发型先兆子痫（11.2/100，000）的产妇死亡率高于无先兆子痫的产妇（4.2/100，000）。早发组中重度孕产妇发病率（不包括产科创伤）为12.2/100例分娩（aOR 3.7，95% CI 3.2-4.3），晚发组中为5.5/100例分娩（aOR 1.7，95% CI 1.6-1.9），无先兆子痫妇女中约为3/100例。早发性先兆子痫导致心血管、呼吸系统、中枢神经系统、肾脏、肝脏和其他疾病的发病率显著升高。然而，产科创伤的发生率显着降低妇女与先兆子痫。结论：早发性和晚发性先兆子痫的妇女有显着较高的特定孕产妇发病率相比，没有早发性和晚发性疾病的妇女。
OBJECTIVE: To examine temporal trends in early-onset compared with late-onset preeclampsia and associated severe maternal morbidity.METHODS: The study included all singleton deliveries in Washington State between 2000 and 2008 (n=670,120). Preeclampsia onset was determined using hospital records linked to birth certificates. Severe maternal morbidity was defined as any potentially life-threatening condition. Logistic regression was used to obtain adjusted odds ratios (aOR) and 95% confidence intervals (95% CI).RESULTS: The preeclampsia rate was 3.0 per 100 singleton births, and increased slightly from 2.9 to 3.1 between 2000 and 2008. Rates of early-onset and late-onset disease were 0.3% and 2.7%, respectively. The temporal increase was significant only for early-onset disease (4.5%/year; 95% CI 2.3-5.8%) after adjustment for changes in maternal characteristics. Maternal death rates were higher among women with early-onset (42.1/100,000 deliveries) and late-onset preeclampsia (11.2/100,000) compared with women without preeclampsia (4.2/100,000). The rate of severe maternal morbidity (excluding obstetric trauma) was 12.2 per 100 deliveries in the early-onset group (aOR 3.7, 95% CI 3.2-4.3), 5.5 per 100 deliveries in the late-onset group (aOR 1.7, 95% CI 1.6-1.9), and approximately 3 per 100 in women without preeclampsia. Early-onset preeclampsia conferred a substantially higher risk of cardiovascular, respiratory, central nervous system, renal, hepatic, and other morbidity. However, rates of obstetric trauma were significantly lower among women with preeclampsia.CONCLUSION: Women with early-onset and late-onset preeclampsia have significantly higher rates of specific maternal morbidity compared with women without early-onset and late-onset disease.