Hereditary Hemorrhagic Telangiectasia: pregnancy and delivery-specific considerations and outcomes.

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

American journal of perinatology Pub Date : 2024-09-24 DOI:10.1055/a-2419-9036

Virginia Watkins, Miriam Estin, Amanda Craig, Sarah Dotters-Katz, Jerome J Federspiel

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引用次数: 0

Abstract

Objective: Prior studies have evaluated maternal outcomes in patients with hereditary hemorrhagic telangiectasia (HHT), yet pregnancy and delivery-specific data remain limited. This study aims to evaluate pregnancy and delivery outcomes in patients with HHT.

Study design: This retrospective cohort study used the Nationwide Readmissions Database to identify patients with HHT diagnosis on delivery between 2010-2021. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included non-transfusion SMM, preterm birth, stillbirth, prelabor rupture of membranes (PROM) or preterm prelabor rupture of membranes (PPROM), cesarean delivery, respiratory bleeding, cerebrovascular complications, patient disposition, and length of stay. Trends in the prevalence of HHT at delivery were assessed with logistic regression. Logistic regression analyses, adjusting for age, payer, zip code income, hospital size and teaching status, were also used to produce adjusted relationships between HHT status and outcomes.

Results: The cohort of 21,698,861 delivered pregnancies corresponded to a national estimate of 44,325,599. Of those, 612 (national estimate: 1,265; 2.8 per 100,000) had a diagnosis of HHT. A steady rise in HHT diagnosis rate during pregnancy from 2010 to 2021 (1.7 per 100,000 in 2010, 3.8 per 100,000 in 2021, p<0.001 for trend) was seen. Patients with HHT were significantly more likely to experience SMM compared to patients without HHT (7.8% vs 1.7%, adjusted relative risk (aRR) 4.49 [95% CI 3.06, 6.58]). Rates of preterm birth (14.2% vs 8.5%, aRR 1.57 [95% CI 1.22, 2.03]), cesarean delivery (41.0% vs 32.9%, aRR 1.23 [95% CI 1.07, 1.41]), respiratory bleeding (2.1% vs <0.1%, aRR 94.44 [56.64, 157.46]) and cerebrovascular complications (0.9% vs <0.1%, aRR 22.89 [9.89, 52.96]) were higher in patients with HHT than non-HHT patients. There was no difference in stillbirth rates between groups.

Conclusion: Patients with HHT have higher rates of SMM and adverse delivery outcomes when compared to the baseline population.

查看原文本刊更多论文

遗传性出血性远端血管扩张症：怀孕和分娩时的具体注意事项和结果。

研究目的先前的研究对遗传性出血性毛细血管扩张症（HHT）患者的妊娠结局进行了评估，但针对妊娠和分娩的数据仍然有限。本研究旨在评估遗传性出血性毛细血管扩张症患者的妊娠和分娩结局：这项回顾性队列研究使用了全国再入院数据库（Nationwide Readmissions Database），以确定 2010-2021 年间在分娩时被诊断为 HHT 的患者。主要结果为严重孕产妇发病率（SMM）。次要结果包括非输血 SMM、早产、死产、产前胎膜破裂 (PROM) 或产前胎膜破裂 (PPROM)、剖宫产、呼吸道出血、脑血管并发症、患者处置和住院时间。通过逻辑回归评估了分娩时 HHT 患病率的变化趋势。逻辑回归分析还对年龄、付款人、邮政编码收入、医院规模和教学地位进行了调整，以得出 HHT 状态与结果之间的调整关系：结果：21,698,861 例分娩妊娠与全国 44,325,599 例估计值相对应。其中 612 例（全国估计值：1 265 例；每 100 000 例中有 2.8 例）确诊为 HHT。从 2010 年到 2021 年，妊娠期 HHT 诊断率稳步上升（2010 年为每 10 万人中 1.7 例，2021 年为每 10 万人中 3.8 例，p 结论：与基线人群相比，HHT 患者的 SMM 和不良分娩结局发生率更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of perinatology 医学-妇产科学

CiteScore

5.90

自引率

0.00%

发文量

302

审稿时长

4-8 weeks

期刊介绍： The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.