Contribution of hypertension to severe maternal morbidity
Contribution of hypertension to severe maternal morbidity
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DOI：
10.1016/j.ajog.2018.07.002
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发表时间：
2018-10-01
影响因子：
9.8
通讯作者：
Easterling, Thomas
中科院分区：
文献类型：
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作者：
Hitti, Jane;Sienas, Laura;Easterling, Thomas
背景：在美国，孕产妇死亡率和严重的孕产妇发病率是日益增长的公共卫生问题。疾病控制和预防中心的严重孕产妇发病率措施提供了深入了解孕产妇死亡率的过程，并可能会突出可修改的危险因素，为不利的孕产妇health outcomes.OBJECTIVE：本研究的主要目的是评估高血压疾病和严重孕产妇发病率之间的关联，在区域围产期转诊中心。我们假设与血压正常的妇女相比，患有重度先兆子痫的妇女有更高的重度孕产妇发病率。我们还评估了入院时出现的严重孕产妇发病率诊断的比例，与分娩住院期间出现的比例形成对比。在这项回顾性横断面分析中，我们评估了严重孕产妇发病率的诊断，（例如，肾功能不全、休克和败血症）和手术（例如，输血和子宫切除术）的所有7025名妇女谁在华盛顿大学医学中心从2013年10月1日至2017年5月31日交付。严重的孕产妇发病率是根据预先规定的国际疾病分类诊断和程序代码确定的;所有诊断均通过病历审查确认。通过由Vizient大学卫生系统联合会提供的医院管理数据计算每种诊断的入院率。比较有和没有严重孕产妇发病率的妇女的人口统计学和临床特征。采用卡方检验和Fisher精确检验确定统计学显著性。优势比和95%的置信区间计算产妇人口统计学和临床特征和严重的孕产妇发病率之间的关联。结果：7025交付，284（4%）有严重的孕产妇发病率，154只输血，27有其他程序，和103名妇女有149个严重的孕产妇发病率诊断（26名妇女有多个诊断）。重度子痫前期发生在438次分娩（6.2%）。值得注意的是，高血压以剂量依赖性方式与重度孕产妇发病率相关，观察到先兆子痫与重度特征的最强相关性（比值比，5.4; 95%置信区间，3.9-7.3）。重度孕产妇发病率也与无重度特征的先兆子痫、慢性高血压、早产、妊娠前糖尿病和多胎妊娠显著相关。在孕产妇发病率高的妇女中，三分之一以上的早产与孕产妇高血压有关。美国印第安人/阿拉斯加原住民妇女的严重孕产妇发病率明显高于其他种族/民族（白人为11.7% vs 3.9%，P
BACKGROUND: Maternal mortality and severe maternal morbidity are growing public health concerns in the United States. The Centers for Disease Control and Prevention Severe Maternal Morbidity measure provides insight into processes underlying maternal mortality and may highlight modifiable risk factors for adverse maternal health outcomes.OBJECTIVE: The primary objective of this study was to evaluate the association between hypertensive disorders and severe maternal morbidity at a regional perinatal referral center. We hypothesized that women with preeclampsia with severe features would have a higher rate of severe maternal morbidity compared to normotensive women. We also assessed the proportion of severe maternal morbidity diagnoses that were present on admission, in contrast to those arising during the delivery hospitalization.STUDY DESIGN: In this retrospective cross-sectional analysis, we assessed rates of severe maternal morbidity diagnoses (eg, renal insufficiency, shock, and sepsis) and procedures (eg, transfusion and hysterectomy) for all 7025 women who delivered at the University of Washington Medical Center from Oct. 1, 2013, through May 31, 2017. Severe maternal morbidity was determined from prespecified International Classification of Diseases diagnosis and procedure codes; all diagnoses were confirmed by chart review. Present-on-admission rates were calculated for each diagnosis through hospital administrative data provided by the Vizient University Health System Consortium. Maternal demographic and clinical characteristics were compared for women with and without severe maternal morbidity. The chi(2) and Fisher exact tests were used to determine statistical significance. Odds ratios and 95% confidence intervals were calculated for the associations between maternal demographic and clinical characteristics and severe maternal morbidity.RESULTS: Of 7025 deliveries, 284 (4%) had severe maternal morbidity; 154 had transfusion only, 27 had other procedures, and 103 women had 149 severe maternal morbidity diagnoses (26 women had multiple diagnoses). Severe preeclampsia occurred in 438 deliveries (6.2%). Notably, hypertension was associated with severe maternal morbidity in a dose-dependent fashion, with the strongest association observed for preeclampsia with severe features (odds ratio, 5.4; 95% confidence interval, 3.9-7.3). Severe maternal morbidity was also significantly associated with preeclampsia without severe features, chronic hypertension, preterm delivery, pregestational diabetes, and multiple gestation. Among women with severe maternal morbidity, over one third of preterm births were associated with maternal hypertension. American Indian/Alaskan Native women had significantly higher severe maternal morbidity rates compared to other racial/ethnic groups (11.7% vs 3.9% for Whites, P