Pare-Miron Valerie, Czuzoj-Shulman Nicholas, Oddy Lisa, Spence Andrea R, Abenhaim Haim Arie
Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada.
Womens Health Issues. 2016 Mar-Apr;26(2):190-5. doi: 10.1016/j.whi.2015.11.001. Epub 2015 Dec 22.
Borderline personality disorder (BPD) is a serious mental disorder commonly associated with functional impairments and adverse health outcomes. Very little is known about BPD in pregnant women; hence, our study objective was to evaluate the effect of BPD on obstetrical and neonatal outcomes.
We carried out a retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample from 2003 to 2012. We identified births using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic and procedure codes and classified women by BPD status. Multivariate logistic regression was used to evaluate the effect of BPD on obstetrical and neonatal outcomes, adjusted for subject baseline characteristics.
During the study period, there were 989 births to women with BPD with an overall incidence of 11.65 in 100,000 births. Women with BPD were more likely younger, of lower socioeconomic status, smoked or used drugs, and had an underlying mental disorder. Unadjusted models revealed that BPD was associated with an increased risk of almost all adverse maternal and fetal outcomes we examined, the exception being post partum hemorrhage and instrumental delivery, which both had a null association with BPD, and induction of labor, which was negatively associated with BPD. Upon full adjustment, BPD was found to be associated with the following obstetrical and neonatal outcomes: gestational diabetes (odds ratio [OR], 1.45; 95% CI, 1.13-1.85), premature rupture of the membranes (OR, 1.40; 95% CI, 1.07-1.83), chorioamnionitis (OR, 1.65; 95% CI, 1.14-2.39), venous thromboembolism (OR, 2.11; 95% CI, 1.12-3.96), caesarian delivery (OR, 1.44; 95% CI, 1.26-1.64), and preterm birth (OR, 1.54; 95% CI, 1.29-1.83).
BPD is associated with several adverse obstetrical and neonatal outcomes. Hence, pregnant women who suffer from BPD should be monitored closely by a multidisciplinary health care team both before and during their pregnancies. This oversight would allow for the receipt of treatment for BPD and also interventions to help them to cease tobacco and drug use, which may ultimately decrease the incidence of poor obstetrical and neonatal outcomes.
边缘型人格障碍（BPD）是一种严重的精神障碍，通常与功能损害和不良健康后果相关。关于孕妇中的BPD知之甚少；因此，我们的研究目的是评估BPD对产科和新生儿结局的影响。
我们使用医疗保健成本和利用项目、2003年至2012年全国住院患者样本进行了一项回顾性队列研究。我们使用国际疾病分类第九版临床修订本（ICD-9-CM）诊断和程序编码来识别分娩情况，并根据BPD状态对女性进行分类。多变量逻辑回归用于评估BPD对产科和新生儿结局的影响，并根据受试者基线特征进行调整。
在研究期间，989名患有BPD的女性分娩，在100,000例分娩中的总体发病率为11.65。患有BPD的女性更可能较年轻、社会经济地位较低、吸烟或使用毒品，并且患有潜在的精神障碍。未经调整的模型显示，BPD与我们研究的几乎所有不良孕产妇和胎儿结局的风险增加相关，但产后出血和器械助产除外，这两者与BPD均无关联，而引产与BPD呈负相关。经过全面调整后，发现BPD与以下产科和新生儿结局相关：妊娠期糖尿病（比值比[OR]，1.45；95%置信区间[CI]，1.13-1.85）、胎膜早破（OR，1.40；95%CI，1.07-1.83）、绒毛膜羊膜炎（OR，1.65；95%CI，1.14-2.39）、静脉血栓栓塞（OR，2.11；95%CI，1.12-3.96）、剖宫产（OR，1.44；95%CI，1.26-1.64）和早产（OR
