Trends, Predictors, and Outcomes of Cardiovascular Complications at Delivery Associated With Gestational Diabetes: A National Inpatient Sample Analysis (2004-2019).
Trends, Predictors, and Outcomes of Cardiovascular Complications at Delivery Associated With Gestational Diabetes: A National Inpatient Sample Analysis (2004-2019).
复制标题
DOI：
10.1161/jaha.122.026786
复制
发表时间：
2022-11
影响因子：
5.4
通讯作者：
Michos, Erin D.
中科院分区：
文献类型：
--
作者：
Zahid, Salman;Hashem, Anas;Minhas, Anum S.;Bennett, Wendy L.;Honigberg, Michael C.;Lewey, Jennifer;Davis, Melinda B.;Michos, Erin D.
妊娠期糖尿病(GD)与长期心血管并发症的风险增加有关。然而，关于急性围产期心血管并发症的数据还没有很好的建立。因此，我们的目标是调查GD与分娩入院时急性心血管结局的关系。我们使用了全国住院患者样本(2004-2019年)的数据。采用国际疾病分类第九版(ICD-9)或第十版(ICD-10)编码识别分娩住院和GD诊断。共有63个 115G002加权住院分娩被确认，其中3.9%为GD患者(n=2 435 301)。在研究期间，GD和肥胖症的患病率都有所增加(P趋势<；0.01)。与非GD患者相比，GD患者肥胖、高血压和血脂异常的患病率更高。在调整了年龄、种族或民族、合并症、保险和收入后，与没有GD相比，GD仍然与心血管并发症独立相关，包括先兆子痫(调整后的优势比[AOR]，1.97[95%CI，1.96-1.98])、围产期心肌病(AOR，1.15[1.08-1.22])、急性肾损伤(AOR，1.16[1.11-1.21])、中风(AOR，1.15[1.09-1.23])和心律失常(AOR，1.48[1.46-1.50])。此外，GD患者分娩住院的时间长短(3 天比2天，P<；0.01)和住院费用(4,909美元比3,682美元，P<；0.01)相关。即使在没有先兆子痫的情况下，GD也与心血管风险增加有关。在分娩住院期间，GD患者患先兆子痫、围产期心肌病、急性肾损伤、中风和心律失常的风险更高。随着全球GD发病率的增加，努力改善先入为主的心脏代谢健康和预防GD可能是改善围产期孕产妇结局和降低长期心血管风险的重要策略。
Gestational diabetes (GD) is associated with increased risk of long‐term cardiovascular complications. However, data on acute peripartum cardiovascular complications are not well established. Hence, we aimed to investigate the association of GD with acute cardiovascular outcomes at the time of delivery admission. We used data from the National Inpatient Sample (2004–2019). International Classification of Diseases, Ninth Revision (ICD‐9) or Tenth Revision (ICD‐10) codes were used to identify delivery hospitalizations and GD diagnosis. A total of 63 115 002 weighted hospitalizations for deliveries were identified, of which 3.9% were among individuals with GD (n=2 435 301). The prevalence of both GD and obesity increased during the study period (P trends<0.01). Individuals with GD versus those without GD had a higher prevalence of obesity, hypertension, and dyslipidemia. After adjustment for age, race or ethnicity, comorbidities, insurance, and income, GD remained independently associated with cardiovascular complications including preeclampsia (adjusted odds ratio [aOR], 1.97 [95% CI, 1.96–1.98]), peripartum cardiomyopathy (aOR, 1.15 [1.08–1.22]), acute kidney injury (aOR, 1.16 [1.11–1.21]), stroke (aOR, 1.15 [1.09–1.23]), and arrhythmias (aOR, 1.48 [1.46–1.50]), compared with no GD. Moreover, delivery hospitalizations among individuals with GD were associated with increased length (3 versus 2 days, P<0.01) and cost of hospitalization ($4909 versus $3682, P<0.01). Even in the absence of preeclampsia, GD was associated with elevated cardiovascular risk. Individuals with GD had a higher risk of preeclampsia, peripartum cardiomyopathy, acute kidney injury, stroke, and arrhythmias during delivery hospitalizations. As rates of GD are increasing globally, efforts to improve preconception cardiometabolic health and prevent GD may represent important strategies to improve peripartum maternal outcomes and mitigate long‐term cardiovascular risk.