子痫的发生率、风险因素及相关并发症。
Incidence, risk factors, and associated complications of eclampsia.
机构信息
From the Health Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada; the Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital of British Columbia, Vancouver, British Columbia, Canada; the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; the Department of Obstetrics and Gynaecology, University of Ottawa and Ottawa Health Research Institute, Ottawa, Ontario, Canada; the Department of Community and Family Health, University of South Florida, Tampa, Florida; the Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; the Departments of Pediatrics & Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; and the Canadian Institutes of Health Research, Ottawa, Ontario, Canada.
出版信息
Obstet Gynecol. 2011 Nov;118(5):987-994. doi: 10.1097/AOG.0b013e31823311c1.
OBJECTIVE
To estimate trends in incidence and identify risk factors and maternal and neonatal consequences of eclampsia in Canada.
METHODS
We conducted a population-based cohort study of all women and their newborns (N=1,910,729) delivered in the hospital in Canada (excluding Quebec) from 2003 to 2009. The data were obtained from the Canadian Institute for Health Information. Logistic models were used to examine the association with potential determinants and consequences of eclampsia.
RESULTS
The incidence of eclampsia declined dramatically from 12.4 per 10,000 deliveries in 2003 to 5.9 in 2009. Among singleton deliveries, nulliparity (adjusted odds ratio [OR] 2.3; 95% confidence interval [CI] 2.0-2.6), anemia (adjusted OR 2.4; 95% CI 2.0-3.0), and existing heart disease (adjusted OR 4.8; 95% CI 2.9-7.3) increased the risk of eclampsia. The declining trend in eclampsia remained unchanged after accounting for changes in potential determinants and risk factors during the study period. Eclampsia was associated with increased risks of maternal death (adjusted OR 26.8; 95% CI 9.7-73.8), assisted ventilation (adjusted OR 102.3; 95% CI 78.2-133.8), respiratory distress syndrome (adjusted OR 36.2; 95% CI 15.3-85.3), acute renal failure (adjusted OR 20.9; 95% CI 11.4-38.3), obstetric embolism (adjusted OR 9.1; 95% CI 4.1-19.9), and other complications. Adverse neonatal outcomes associated with eclampsia included neonatal death (adjusted OR 2.9; 95% CI 1.6-5.5), respiratory distress syndrome (adjusted OR 5.1; 95% CI 4.1-6.3), and small-for-gestational age birth (adjusted OR 2.6; 95% CI 2.3-3.0).
CONCLUSION
Despite declining incidence and improved care of women with eclampsia, the condition remains strongly associated with serious adverse consequences.
目的
评估加拿大子痫前期的发病趋势，确定其危险因素及母婴结局。
方法
本研究采用加拿大医院（魁北克除外）2003 年至 2009 年间所有产妇及其新生儿（n=1910729）的基于人群的队列研究数据，资料来源于加拿大健康信息研究所。采用逻辑回归模型分析子痫前期的相关潜在决定因素及母婴结局。
结果
2003 年，子痫前期的发病率为 12.4/10000 分娩，到 2009 年下降至 5.9/10000 分娩。在单胎分娩中，初产妇（校正比值比[OR]2.3；95%置信区间[CI]2.0-2.6）、贫血（校正 OR 2.4；95% CI 2.0-3.0）和原有心脏病（校正 OR 4.8；95% CI 2.9-7.3）会增加子痫前期的发病风险。在研究期间，尽管潜在决定因素和危险因素发生了变化，但子痫前期的发病趋势仍呈下降趋势。子痫前期与产妇死亡率增加（校正 OR 26.8；95% CI 9.7-73.8）、辅助通气（校正 OR 102.3；95% CI 78.2-133.8）、呼吸窘迫综合征（校正 OR 36.2；95% CI 15.3-85.3）、急性肾衰竭（校正 OR 20.9；95% CI 11.4-38.3）、产科栓塞（校正 OR 9.1；95% CI 4.1-19.9）和其他并发症的风险增加相关。与子痫前期相关的不良新生儿结局包括新生儿死亡（校正 OR 2.9；95% CI 1.6-5.5）、呼吸窘迫综合征（校正 OR 5.1；95% CI 4.1-6.3）和小于胎龄儿（校正 OR 2.6；95% CI 2.3-3.0）。
结论
尽管子痫前期的发病率下降，母婴护理水平提高，但该疾病与严重不良后果仍密切相关。
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