A retrospective analysis of complications associated with postpartum hemorrhage up to 1 year postpartum in mothers with and without a pre-existing mental health diagnosis.
A retrospective analysis of complications associated with postpartum hemorrhage up to 1 year postpartum in mothers with and without a pre-existing mental health diagnosis.
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DOI：
10.1177/17455057231211094
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发表时间：
2023-01
期刊：
影响因子：
2.4
通讯作者：
Jasani, Sona
中科院分区：
文献类型：
--
作者：
Endres, Kodi;Razavi, Nina;Tian, Zizhong;Zhou, Shouhao;Krawiec, Conrad;Jasani, Sona
关于产后出血相关的近期和长期结局的研究有限。分娩前有精神疾病的母亲可能特别容易发生产后出血，但对此知之甚少。研究这一人群的障碍存在，并增加了知识差距。本研究的目的是确定产后出血诊断后1年内并发症的临床特征和频率，以及产后出血诊断后7天内精神后遗症的母亲在分娩前与那些没有预先存在的精神健康诊断。这是一项多中心回顾性观察性队列研究，使用TriNetX，一种去识别的电子健康记录数据库。在阴道分娩或剖宫产的产后女性中收集并评价了以下电子健康记录数据：年龄、人种、种族、诊断代码、药物代码和死亡人数。我们纳入了10，649例受试者（6994例（65.7%）无心理健康诊断，3655例（34.3%）既存心理健康诊断）。氟哌啶醇给药（118例（3.2%）vs 129例（1.8%），p < 0.001）在既存精神健康诊断的受试者中更普遍。根据人口统计学调整后，先前存在的心理健康诊断与产后出血诊断后1年内的并发症相关（OR = 1.39，95%CI：1.26-1.52，p < 0.001）。有精神健康障碍史与产后出血诊断后1年内发生后续并发症的几率较高相关。有心理健康障碍的母亲发生某些严重产后出血后遗症的频率明显较高，包括急性呼吸窘迫综合征、胎盘滞留、镰状细胞危象和分娩后1年内需要机械通气/气管切开术。这些母亲在产后出血诊断后7天内服用氟哌啶醇等药物的频率也更高。需要进一步的研究来了解和管理产后出血在这个脆弱的产妇群体中的独特后果。
There is limited research on the associated immediate and long-term outcomes of postpartum hemorrhage. Mothers with a pre-existing psychiatric disease prior to delivery may be especially vulnerable to postpartum hemorrhage outcomes but little is known on this topic. Barriers to studying this population exist and add to knowledge gaps. The goal of this study is to determine the clinical characteristics and frequency of complications within 1 year of a postpartum hemorrhage diagnosis and the psychiatric sequelae within 7 days of a postpartum hemorrhage diagnosis in mothers with a pre-existing mental health diagnosis prior to delivery versus those without. This is a multicenter retrospective observational cohort study using TriNetX, a de-identified electronic health record database. The following electronic health record data were collected and evaluated in postpartum females who were billed for either a vaginal or cesarean delivery: age, race, ethnicity, diagnostic codes, medication codes, and number of deaths. We included 10,649 subjects (6994 (65.7%) no mental health diagnosis and 3655 (34.3%) pre-existing mental health diagnosis). Haloperidol administration (118 (3.2%) versus 129 (1.8%), p < 0.001) was more prevalent in subjects with a pre-existing mental health diagnosis. Adjusting for demographics, pre-existing mental health diagnoses were associated with complications within 1 year after postpartum hemorrhage diagnosis (OR = 1.39, 95% CI: 1.26–1.52, p < 0.001). Having a mental health disorder history is associated with a higher odds of developing subsequent complications within 1 year of postpartum hemorrhage diagnosis. Mothers with a pre-existing mental health disorder have a significantly higher frequency of certain severe postpartum hemorrhage sequelae, including acute respiratory distress syndrome, retained placenta, sickle cell crisis, and need for mechanical ventilation/tracheostomy up to 1 year after delivery. Medications such as haloperidol were ordered more frequently within 7 days of a postpartum hemorrhage diagnosis in these mothers as well. Further research is needed to understand and manage the unique consequences of postpartum hemorrhage in this vulnerable maternal population.
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