{"title":"母胎医师密度与妊娠结局的关系。","authors":"Tetsuya Kawakita, Rula Atwani, Misa Hayasaka, Lindsay Speros Robbins, George Saade","doi":"10.1055/a-2717-3951","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level.</p><p><strong>Study design: </strong>This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state categorized into three groups: (1) low density (<30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models.</p><p><strong>Results: </strong>Overall, there were 14,771,547 live births, 3,440 maternal mortality, 4,980 pregnancy-related mortality, and 90,848 stillbirths included. The median MFM density across states was 31.6 per 100,000 live births (interquartile range: 21.9-42.5). States with high MFM density had a reduced risk of maternal mortality (aIRR 0.70; 95% CI 0.58-0.85) and pregnancy-related mortality (aIRR 0.83; 95% CI 0.71-0.98) compared to states with low MFM density, corresponding to 7.29 (AME 95% CI 3.58-11.00) and 5.57 (AME 95% CI 0.74-10.40) less mortality per 100,000 live births, respectively. States with moderate MFM density had a similar risk of maternal mortality compared to low MFM density states (aIRR 1.02; 95% CI 0.87-1.20).</p><p><strong>Conclusions: </strong>High MFM-density states have a decreased risk of maternal mortality compared to low MFM-density states, suggesting a critical role of MFM in reducing maternal mortality.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2000,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Association between Maternal-Fetal Medicine Physician Density and Pregnancy Outcomes.\",\"authors\":\"Tetsuya Kawakita, Rula Atwani, Misa Hayasaka, Lindsay Speros Robbins, George Saade\",\"doi\":\"10.1055/a-2717-3951\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level.</p><p><strong>Study design: </strong>This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state categorized into three groups: (1) low density (<30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models.</p><p><strong>Results: </strong>Overall, there were 14,771,547 live births, 3,440 maternal mortality, 4,980 pregnancy-related mortality, and 90,848 stillbirths included. The median MFM density across states was 31.6 per 100,000 live births (interquartile range: 21.9-42.5). States with high MFM density had a reduced risk of maternal mortality (aIRR 0.70; 95% CI 0.58-0.85) and pregnancy-related mortality (aIRR 0.83; 95% CI 0.71-0.98) compared to states with low MFM density, corresponding to 7.29 (AME 95% CI 3.58-11.00) and 5.57 (AME 95% CI 0.74-10.40) less mortality per 100,000 live births, respectively. States with moderate MFM density had a similar risk of maternal mortality compared to low MFM density states (aIRR 1.02; 95% CI 0.87-1.20).</p><p><strong>Conclusions: </strong>High MFM-density states have a decreased risk of maternal mortality compared to low MFM-density states, suggesting a critical role of MFM in reducing maternal mortality.</p>\",\"PeriodicalId\":7584,\"journal\":{\"name\":\"American journal of perinatology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2025-10-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of perinatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2717-3951\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of perinatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2717-3951","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：我们试图在州一级检查母胎医学（MFM）医师密度与不良妊娠结局之间的关系。研究设计：这是对2018年至2021年公开可用的州级数据的横断面分析，包括出生、多种死因和胎儿死亡数据库。从美国医学协会的主档案中获得了每个州每年活跃的MFM医生人数。主要暴露是每个州的MFM密度，分为三组：(1)低密度(结果：总体而言，有14,771,547例活产，3,440例孕产妇死亡，4,980例妊娠相关死亡，90,848例死产。各州的MFM密度中位数为每10万活产31.6例（四分位数范围：21.9-42.5）。与MFM密度低的州相比，MFM密度高的州的孕产妇死亡率（aIRR 0.70; 95% CI 0.58-0.85）和妊娠相关死亡率（aIRR 0.83; 95% CI 0.71-0.98）的风险较低，对应的每10万活产死亡率分别降低7.29 （AME 95% CI 3.58-11.00）和5.57 （AME 95% CI 0.74-10.40）。与低MFM密度州相比，中等MFM密度州的孕产妇死亡风险相似（aIRR 1.02; 95% CI 0.87-1.20）。结论：与低MFM密度国家相比，高MFM密度国家的孕产妇死亡率风险降低，这表明MFM在降低孕产妇死亡率方面发挥了关键作用。
The Association between Maternal-Fetal Medicine Physician Density and Pregnancy Outcomes.
Objective: We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level.
Study design: This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state categorized into three groups: (1) low density (<30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models.
Results: Overall, there were 14,771,547 live births, 3,440 maternal mortality, 4,980 pregnancy-related mortality, and 90,848 stillbirths included. The median MFM density across states was 31.6 per 100,000 live births (interquartile range: 21.9-42.5). States with high MFM density had a reduced risk of maternal mortality (aIRR 0.70; 95% CI 0.58-0.85) and pregnancy-related mortality (aIRR 0.83; 95% CI 0.71-0.98) compared to states with low MFM density, corresponding to 7.29 (AME 95% CI 3.58-11.00) and 5.57 (AME 95% CI 0.74-10.40) less mortality per 100,000 live births, respectively. States with moderate MFM density had a similar risk of maternal mortality compared to low MFM density states (aIRR 1.02; 95% CI 0.87-1.20).
Conclusions: High MFM-density states have a decreased risk of maternal mortality compared to low MFM-density states, suggesting a critical role of MFM in reducing maternal mortality.
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.
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