Pregnancy outcomes in systemic sclerosis, primary pulmonary hypertension, and sickle cell disease
Pregnancy outcomes in systemic sclerosis, primary pulmonary hypertension, and sickle cell disease
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DOI：
10.1097/01.aog.0000308710.86880.a6
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发表时间：
2008-04-01
影响因子：
7.2
通讯作者：
Chung, Lorinda
中科院分区：
文献类型：
--
作者：
Chakravarty, Eliza F.;Khanna, Dinesh;Chung, Lorinda
目的：系统性硬化症、原发性肺动脉高压和镰状细胞病是影响女性的罕见血管病变。我们估计了全国范围内有这些情况的妇女怀孕的发生率，并将怀孕结果与普通产科人群进行了比较。我们研究了2002-2004年全国住院患者样本，医疗保健成本和利用项目，以估计系统性硬化症，原发性肺动脉高压，镰状细胞病，和女性的比例。妊娠结局包括住院时间、高血压疾病（包括先兆子痫）、宫内生长受限（IUGR）和剖宫产。多变量回归分析进行了母亲的年龄，种族或民族，抗磷脂抗体综合征，糖尿病，肾功能衰竭作为covariates.RESULTS：估计1120万交付，504发生在妇女与系统性硬化症，182原发性肺动脉高压，4,352镰状细胞病。系统性硬化症与高血压疾病风险增加相关，包括先兆子痫（比值比[OR] 3.71，95%置信区间[CI] 2.25-6.15）、IUGR（OR 3.74，95% CI 1.51-9.28）和住院时间延长。原发性肺动脉高压与产前住院（OR 4.67，95%CI 2.88-7.57）、高血压疾病（包括先兆子痫）（OR 5.62，95%CI 2.60-12.15）和住院时间显著增加相关。镰状细胞病与产前住院的几率增加有关（OR 5.56 95% CI 5.08-6.09），高血压疾病，包括先兆子痫（OR 1.78，95% CI 1.48-2.14）和IUGR（OR 2.91，95%CI 2.16-3.93），住院时间略有增加。结论：患有系统性硬化症、原发性肺动脉高压和镰状细胞病的妇女不良妊娠结局的发生率显著增加，需要关于怀孕风险的广泛的孕前咨询。
OBJECTIVE: Systemic sclerosis, primary pulmonary hypertension, and sickle cell disease are uncommon vasculopathic diseases affecting women. We estimated the nationwide occurrence of pregnancies in women with these conditions and compared pregnancy outcomes to the general obstetric population.METHODS: We studied the 2002-2004 Nationwide Inpatient Sample, of the Healthcare Cost and Utilization Project to estimate the number of obstetric hospitalizations and deliveries among women with systemic sclerosis, primary pulmonary hypertension, sickle cell disease, and women in the general population. Pregnancy outcomes included length of hospital stay, hypertensive disorders including preeclampsia, intrauterine growth restriction (IUGR), and cesarean delivery. Multivariable regression analyses were performed using maternal age, race or ethnicity, antiphospholipid antibody syndrome, diabetes mellitus, and renal failure as covariates.RESULTS: Of an estimated 11.2 million deliveries, 504 occurred in women with systemic sclerosis, 182 with primary pulmonary hypertension, and 4,352 with sickle cell disease. Systemic sclerosis, was associated with an increased risk of hypertensive disorders including preeclampsia (odds ratio [OR] 3.71, 95% confidence interval [CI] 2.25-6.15), IUGR (OR 3.74, 95% CI 1.51-9.28), and increased length of hospital stay. Primary pulmonary hypertension was associated with an increase in the odds of antenatal hospitalization (OR 4.67, 95% CI 2.88-7.57), hypertensive disorders including preeclampsia (OR 5.62, 95% CI 2.60-12.15) and a substantial increase in length of hospital stay. Sickle cell disease was associated with an increased odds of antenatal hospitalization (OR 5.56 95% CI 5.08-6.09), hypertensive disorders including preeclampsia (OR 1.78, 95% CI 1.48-2.14), and IUGR (OR 2.91, 95% CI 2.16-3.93), with a modest increase in length of hospital stay.CONCLUSION: Women with systemic sclerosis, primary pulmonary hypertension, and sickle cell disease have significantly increased rates of adverse pregnancy outcomes, requiring extensive preconceptional counseling about the risks of pregnancy.