妊娠合并血管性血友病住院分娩期间产妇结局的当代趋势——横断面分析

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-08-01 DOI:10.1016/j.rpth.2025.103174

Minhazur R. Sarker , Rachel Wiley , Vishesh Khanna , Alexander M. Friedman , Timothy Wen

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引用次数: 0

摘要

虽然基于指南的多学科护理越来越强调妊娠期血管性血液病（VWD）的管理，但大多数结局数据来自过时的研究。目的本研究旨在评估VWD患病率的时间趋势，估计VWD的出血并发症趋势，并研究VWD与不良妊娠结局的关系。方法利用2000年至2022年全国住院患者样本数据进行横断面分析，并使用国际疾病分类代码确定VWD分娩住院情况。结果包括胎盘早剥或产前出血、产后出血、输血、非输血严重产妇发病率、剖宫产和阴道手术分娩。通过估计年平均百分比变化，采用连接点回归分析趋势。使用未调整和调整的logistic回归模型来确定VWD与不良妊娠结局之间的关联强度。结果87,151,596例分娩住院患者中，每10,000人中有4.2例诊断为VWD。2000年至2022年期间，VWD患病率从每10,000例分娩2.1例上升至5.1例（年均百分比变化6.6%；95%置信区间5.3%-19.5%）。VWD分娩住院与产前出血、产后出血、输血、非输血严重产妇发病率和剖宫产率增加有关。在这些关联中，在研究期间，VWD分娩的产前出血和输血率显著下降，分娩方式显示阴道手术分娩减少。结论输血率和产前出血率的下降表明妊娠期VWD的诊断和处理有所改善。然而，稳定的产后出血率突出了护理方面的持续差距。这些当代人群水平的发现将为VWD患者提供孕前咨询和分娩计划。

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Contemporary trends in maternal outcomes during delivery hospitalizations among pregnancies complicated by von Willebrand disease—a cross-sectional analysis

Background

While guideline-based multidisciplinary care is increasingly emphasized for managing von Willebrand disease (VWD) in pregnancy, most outcomes data are derived from outdated studies.

Objectives

This study aimed to evaluate temporal trends in the prevalence of VWD, estimate hemorrhagic complication trends with VWD, and examine associations with adverse pregnancy outcomes with VWD.

Methods

We conducted a cross-sectional analysis leveraging data from the National Inpatient Sample from 2000 to 2022 and identified VWD delivery hospitalizations using International Classification of Diseases codes. Outcomes included placental abruption or antepartum hemorrhage, postpartum hemorrhage, transfusion, nontransfusion severe maternal morbidity, and cesarean and operative vaginal delivery. Joinpoint regression was used to analyze trends by estimating the average annual percentage change. Unadjusted and adjusted logistic regression models were used to determine the strength of association between VWD and adverse pregnancy outcomes.

Results

Among 87,151,596 delivery hospitalizations, 4.2 per 10,000 had a diagnosis of VWD. VWD prevalence rose from 2.1 to 5.1 per 10,000 deliveries between 2000 and 2022 (average annual percentage change, 6.6%; 95% CI, 5.3%-19.5%). Delivery hospitalizations with VWD were associated with increased rates of antepartum hemorrhage, postpartum hemorrhage, transfusion, nontransfusion severe maternal morbidity, and cesarean delivery. Of these associations, during the study period for deliveries with VWD, rates of antepartum hemorrhage and transfusion decreased significantly, and delivery route showed a decrease in operative vaginal delivery.

Conclusion

Declining transfusion and antepartum hemorrhage rates suggest improvements in diagnosis and management of VWD during pregnancy. However, stable rates of postpartum hemorrhage rate highlight continued gaps in care. These contemporary, population-level findings will inform preconception counseling and intrapartum planning for individuals with VWD.

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