Alice H Linder, Timothy Wen, Jean R Guglielminotti, Lisa D Levine, Yuli Y Kim, Stephanie E Purisch, Mary E D'Alton, Alexander M Friedman
{"title":"2000-2018年孕产妇先天性心脏病的分娩结局","authors":"Alice H Linder, Timothy Wen, Jean R Guglielminotti, Lisa D Levine, Yuli Y Kim, Stephanie E Purisch, Mary E D'Alton, Alexander M Friedman","doi":"10.1080/14767058.2022.2081803","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To characterize temporal trends and outcomes of delivery hospitalization with maternal congenital heart disease (CHD).</p><p><strong>Materials and methods: </strong>For this repeated cross-sectional analysis, deliveries to women aged 15-54 years with maternal CHD were identified in the 2000-2018 National Inpatient Sample. Temporal trends in maternal CHD were analyzed using joinpoint regression to estimate the average annual percentage change (AAPC) with 95% CIs. The relationship between maternal CHD and several adverse maternal outcomes was analyzed with log-linear regression models. Risk for adverse outcomes in the setting of maternal CHD was further characterized based on additional diagnoses of cardiac comorbidity including congestive heart failure, arrhythmia, valvular disease, pulmonary disorders, and history of thromboembolism.</p><p><strong>Results: </strong>Of 73,109,790 delivery hospitalizations, 51,841 had a diagnosis of maternal CHD (7.1 per 10,000). Maternal CHD rose from 4.2 to 10.9 per 10,000 deliveries (AAPC 4.8%, 95% CI 4.2%, 5.4%). Maternal CHD deliveries with a cardiac comorbidity diagnosis also increased from 0.6 to 2.6 per 10,000 from 2000 to 2018 (AAPC 8.4%, 95% CI 6.3%, 10.6%). Maternal CHD was associated with severe maternal morbidity (adjusted risk ratios [aRR] 4.97, 95% CI 4.75, 5.20), cardiac severe maternal morbidity (aRR 7.65, 95% CI 7.14, 8.19), placental abruption (aRR 1.30, 95% 1.21, 1.38), preterm delivery (aRR 1.47, 95% CI 1.43, 1.51), and transfusion (aRR 2.28, 95% CI 2.14, 2.42). Risk for severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) and cardiac severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) increased significantly among women with maternal CHD over the study period. The presence of cardiac comorbidity diagnoses was associated with further increased risk.</p><p><strong>Conclusion: </strong>Maternal CHD is becoming more common among US deliveries. Among deliveries with maternal CHD, risk for severe morbidity is increasing. These findings support that an increasing burden of risk from maternal CHD in the obstetric population.</p>","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9691578/pdf/","citationCount":"0","resultStr":"{\"title\":\"Delivery outcomes associated with maternal congenital heart disease, 2000-2018.\",\"authors\":\"Alice H Linder, Timothy Wen, Jean R Guglielminotti, Lisa D Levine, Yuli Y Kim, Stephanie E Purisch, Mary E D'Alton, Alexander M Friedman\",\"doi\":\"10.1080/14767058.2022.2081803\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To characterize temporal trends and outcomes of delivery hospitalization with maternal congenital heart disease (CHD).</p><p><strong>Materials and methods: </strong>For this repeated cross-sectional analysis, deliveries to women aged 15-54 years with maternal CHD were identified in the 2000-2018 National Inpatient Sample. Temporal trends in maternal CHD were analyzed using joinpoint regression to estimate the average annual percentage change (AAPC) with 95% CIs. The relationship between maternal CHD and several adverse maternal outcomes was analyzed with log-linear regression models. Risk for adverse outcomes in the setting of maternal CHD was further characterized based on additional diagnoses of cardiac comorbidity including congestive heart failure, arrhythmia, valvular disease, pulmonary disorders, and history of thromboembolism.</p><p><strong>Results: </strong>Of 73,109,790 delivery hospitalizations, 51,841 had a diagnosis of maternal CHD (7.1 per 10,000). Maternal CHD rose from 4.2 to 10.9 per 10,000 deliveries (AAPC 4.8%, 95% CI 4.2%, 5.4%). Maternal CHD deliveries with a cardiac comorbidity diagnosis also increased from 0.6 to 2.6 per 10,000 from 2000 to 2018 (AAPC 8.4%, 95% CI 6.3%, 10.6%). Maternal CHD was associated with severe maternal morbidity (adjusted risk ratios [aRR] 4.97, 95% CI 4.75, 5.20), cardiac severe maternal morbidity (aRR 7.65, 95% CI 7.14, 8.19), placental abruption (aRR 1.30, 95% 1.21, 1.38), preterm delivery (aRR 1.47, 95% CI 1.43, 1.51), and transfusion (aRR 2.28, 95% CI 2.14, 2.42). Risk for severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) and cardiac severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) increased significantly among women with maternal CHD over the study period. The presence of cardiac comorbidity diagnoses was associated with further increased risk.</p><p><strong>Conclusion: </strong>Maternal CHD is becoming more common among US deliveries. Among deliveries with maternal CHD, risk for severe morbidity is increasing. These findings support that an increasing burden of risk from maternal CHD in the obstetric population.</p>\",\"PeriodicalId\":22921,\"journal\":{\"name\":\"The Journal of Maternal-Fetal & Neonatal Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9691578/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Journal of Maternal-Fetal & Neonatal Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1080/14767058.2022.2081803\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/6/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of Maternal-Fetal & Neonatal Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/14767058.2022.2081803","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/6/5 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的:探讨产妇先天性心脏病(CHD)分娩住院的时间趋势和结局。材料和方法:对于这项重复的横断面分析，在2000-2018年全国住院患者样本中确定了15-54岁产妇冠心病的分娩情况。使用联结点回归分析产妇冠心病的时间趋势，以95% ci估计平均年百分比变化(AAPC)。采用对数-线性回归模型分析产妇冠心病与几种不良结局的关系。根据其他心脏合并症的诊断，包括充血性心力衰竭、心律失常、瓣膜疾病、肺部疾病和血栓栓塞史，孕妇冠心病的不良结局风险进一步表征。结果:在73,109,790例分娩住院患者中，51,841例诊断为产妇冠心病(7.1 / 10,000)。产妇冠心病发生率从4.2 / 10000上升到10.9 / 10000 (AAPC 4.8%， 95% CI 4.2%， 5.4%)。从2000年到2018年，患有心脏合并症的产妇冠心病分娩也从0.6 / 10,000增加到2.6 / 10,000 (AAPC 8.4%， 95% CI 6.3%， 10.6%)。产妇冠心病与严重产妇发病率(校正风险比[aRR] 4.97, 95% CI 4.75, 5.20)、心脏严重产妇发病率(aRR 7.65, 95% CI 7.14, 8.19)、胎盘早裂(aRR 1.30, 95% CI 1.21, 1.38)、早产(aRR 1.47, 95% CI 1.43, 1.51)和输血(aRR 2.28, 95% CI 2.14, 2.42)相关。在研究期间，母亲患有冠心病的女性严重发病率(AAPC 4.7%， 95% CI 2.5%， 6.9%)和心脏严重发病率(AAPC 4.7%， 95% CI 2.5%， 6.9%)的风险显著增加。心脏合并症诊断的存在与进一步增加的风险相关。结论:产妇冠心病在美国分娩中越来越普遍。在产妇冠心病分娩中，严重发病的风险正在增加。这些发现支持产科人群中孕产妇冠心病风险负担的增加。
Delivery outcomes associated with maternal congenital heart disease, 2000-2018.
Purpose: To characterize temporal trends and outcomes of delivery hospitalization with maternal congenital heart disease (CHD).
Materials and methods: For this repeated cross-sectional analysis, deliveries to women aged 15-54 years with maternal CHD were identified in the 2000-2018 National Inpatient Sample. Temporal trends in maternal CHD were analyzed using joinpoint regression to estimate the average annual percentage change (AAPC) with 95% CIs. The relationship between maternal CHD and several adverse maternal outcomes was analyzed with log-linear regression models. Risk for adverse outcomes in the setting of maternal CHD was further characterized based on additional diagnoses of cardiac comorbidity including congestive heart failure, arrhythmia, valvular disease, pulmonary disorders, and history of thromboembolism.
Results: Of 73,109,790 delivery hospitalizations, 51,841 had a diagnosis of maternal CHD (7.1 per 10,000). Maternal CHD rose from 4.2 to 10.9 per 10,000 deliveries (AAPC 4.8%, 95% CI 4.2%, 5.4%). Maternal CHD deliveries with a cardiac comorbidity diagnosis also increased from 0.6 to 2.6 per 10,000 from 2000 to 2018 (AAPC 8.4%, 95% CI 6.3%, 10.6%). Maternal CHD was associated with severe maternal morbidity (adjusted risk ratios [aRR] 4.97, 95% CI 4.75, 5.20), cardiac severe maternal morbidity (aRR 7.65, 95% CI 7.14, 8.19), placental abruption (aRR 1.30, 95% 1.21, 1.38), preterm delivery (aRR 1.47, 95% CI 1.43, 1.51), and transfusion (aRR 2.28, 95% CI 2.14, 2.42). Risk for severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) and cardiac severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) increased significantly among women with maternal CHD over the study period. The presence of cardiac comorbidity diagnoses was associated with further increased risk.
Conclusion: Maternal CHD is becoming more common among US deliveries. Among deliveries with maternal CHD, risk for severe morbidity is increasing. These findings support that an increasing burden of risk from maternal CHD in the obstetric population.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
