Estimated Prevalence of Risk Factors for Preeclampsia Among Individuals Giving Birth in the US in 2019.
Estimated Prevalence of Risk Factors for Preeclampsia Among Individuals Giving Birth in the US in 2019.
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DOI：
10.1001/jamanetworkopen.2021.42343
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发表时间：
2022-01-04
影响因子：
13.8
通讯作者：
Myers ER
中科院分区：
文献类型：
--
作者：
Wheeler SM;Myers SO;Swamy GK;Myers ER
本队列研究评估了妊娠患者预防性低剂量阿司匹林指南中使用的先兆子痫危险因素的人群水平患病率，以及这些危险因素与妊娠相关高血压报告率的相关性。妊娠患者预防性低剂量阿司匹林指南中使用的先兆子痫危险因素的患病率是多少？在这项队列研究中，2019年在美国记录了所有3695019例分娩; 4.5%的分娩有1个或多个高风险因素，81.1%的分娩有1个或多个先兆子痫的中度风险。符合2021年推荐或考虑使用低剂量阿司匹林标准的孕妇占2019年出生人数的85.7%，占记录在案的妊娠相关高血压的92.3%。简化指南推荐LDA给有任何单一中度风险因素的患者或通用方法值得进一步考虑。低剂量阿司匹林（LDA）是为数不多的用于预防先兆子痫的循证干预措施之一，先兆子痫是孕产妇或胎儿发病率和死亡率的主要原因。目前的指南建议LDA基于先兆子痫的危险因素的存在，但这些因素的人群患病率是未知的。估计妊娠患者预防性LDA指南中使用的先兆子痫危险因素的人群水平患病率，以及这些危险因素与妊娠相关高血压报告率的相关性。使用国家卫生统计中心出生证明数据进行了一项回顾性队列研究，以描述具有先兆子痫中高危因素和妊娠相关高血压发生率的孕妇的频率。该研究使用了2019年美国的所有出生记录。先兆子痫危险因素的记录：多胎妊娠、妊娠前糖尿病、慢性高血压（高危因素）和未产妇、体重指数大于30、非裔美国人、母亲年龄35岁或以上、距上次分娩间隔超过10年、社会经济地位低（中等风险因素）。导致推荐LDA的每个风险因素单独和组合的患病率;按风险因素和风险因素组合列出的妊娠相关高血压的发病率。2019年有3695019例妊娠，其中528778例无危险因素，169540例有1个或多个高危因素，2996701例有1个或多个中危因素。队列的平均（SD）为29.1（5.8）岁。多胎妊娠是最常见的高危因素，在123995例妊娠中发现（3.4%），低社会经济地位是最常见的中度危险因素，在1732729例妊娠中发现（46.9%）。根据2021标准（先兆子痫的单一高或中度风险因素），3166241例妊娠患者（85.7%）符合LDA的条件。妊娠高血压的发病率随着中度危险因素的增加而增加。2021年指南建议在92.3%诊断为妊娠相关高血压的妊娠中考虑或推荐LDA。这些数据支持最近发表的指南，并建议进一步简化指南，推荐LDA的患者与任何单一的中度风险因素。
This cohort study estimates the population-level prevalence of preeclampsia risk factors used in prophylactic low-dose aspirin guidelines for pregnant patients and the association of these risk factors with reported rates of pregnancy-related hypertension. What is the prevalence of preeclampsia risk factors used in prophylactic low-dose aspirin guidelines for pregnant patients? In this cohort study of all 3 695 019 recorded deliveries in the US in 2019; 4.5% of deliveries had 1 or more high-risk factors and 81.1% of deliveries had 1 or more moderate risks for preeclampsia. Pregnant patients meeting 2021 criteria to recommend or consider low-dose aspirin accounted for 85.7% of births and 92.3% of documented pregnancy-related hypertension in 2019. Simplified guidelines recommending LDA to patients with any single moderate-risk factor or a universal approach warrant further consideration. Low-dose aspirin (LDA) is one of the few evidence-based interventions for preventing preeclampsia, which is a leading cause of maternal or fetal morbidity and mortality. Current guidelines recommend LDA based on the presence of risk factors for preeclampsia, but the population-based prevalence of these factors is unknown. To estimate population-level prevalence of preeclampsia risk factors used in prophylactic LDA guidelines for pregnant patients and the association of these risk factors with reported rates of pregnancy-related hypertension. A retrospective cohort study was conducted using National Center for Health Statistics birth certificate data to describe the frequency of pregnant individuals with moderate to high-risk factors for preeclampsia and pregnancy-related hypertension rates. The study used all birth records in the United States for the 2019 calendar year. Documentation of preeclampsia risk factors: multifetal gestation, pregestational diabetes, chronic hypertension (high-risk factors) and nulliparity, a body mass index greater than 30, African American race, a maternal age 35 years or older, an interval of more than 10-years since last birth, and having low socioeconomic status (moderate risk factors). Prevalence of each risk factor alone and in combinations leading to a recommendation for LDA; incidence of pregnancy-related hypertension by risk factor and combinations of risk factors. There were 3 695 019 pregnancies in 2019, including 528 778 with no risk factors, 169 540 with 1 or more high-risk factors, and 2 996 701 with 1 or more moderate-risk factors. The mean (SD) of the cohort was 29.1 (5.8) years. Multifetal gestation was the most common high-risk factor and found in 123 995 pregnancies (3.4%), and low socioeconomic status was the most common moderate-risk factor and present in 1 732 729 pregnancies (46.9%). Based on 2021 criteria (a single high- or moderate-risk factors for preeclampsia), 3 166 241 pregnant patients (85.7%) were eligible for LDA. The incidence of pregnancy-related hypertension increased with the number of moderate-risk factors. The 2021 guidelines suggest considering or recommend LDA in 92.3% of pregnancies diagnosed with pregnancy-related hypertension. These data support the recently published guidelines and suggest further simplified guidelines recommending LDA to patients with any single moderate-risk factors.
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作者：
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作者：
Mallampati, Divya;Grobman, William;Werner, Erika F.
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作者：
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通讯作者：
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DOI：
10.15585/mmwr.rr7005a1
发表时间：
2021-08-27
期刊：
MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports
影响因子：
--
作者：
Grohskopf LA;Alyanak E;Ferdinands JM;Broder KR;Blanton LH;Talbot HK;Fry AM
通讯作者：
Fry AM