Metcalfe Amy, Wick James, Ronksley Paul
Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Acta Obstet Gynecol Scand. 2018 Jan;97(1):89-96. doi: 10.1111/aogs.13245. Epub 2017 Nov 1.
Severe maternal morbidity and mortality have increased in the USA in recent years. This trend has not been consistent across all racial groups. The reasons behind this, and the relation between preexisting conditions, pregnancy-associated disease and severe maternal morbidity/mortality, have not been fully explored.
Annual data on delivery hospitalizations between 1993 and 2012 were obtained from the Nationwide Inpatient Sample (NIS), representing a 20% sample of hospital discharges from across the USA. Chi-square tests for trend were used to examine temporal patterns in the proportion of pregnancies affected by comorbidities as defined by the Obstetric Comorbidity Score and were stratified by maternal race. Logistic regression was used to determine the impact of temporal increases in comorbidity on severe maternal morbidity/mortality.
In 1993, 34.3% of pregnancies had a comorbidity score of ≥1; this significantly increased to 44.1% by 2012 (p < 0.001). Baseline differences were observed between all races (Whites 33.7%, Blacks 34.5%, Hispanics 28.0%, Asian/Pacific Islanders 28.1%). Although significant increases were observed for all races, the relative rate of change was lowest for Whites (26.1% increase) and highest for Asian/Pacific Islanders (49.1% increase). The odds of severe maternal morbidity/mortality have steadily increased over time; however, adjustment for Obstetric Comorbidity Score significantly attenuates this correlation.
The rate of both preexisting comorbidities and pregnancy-associated disease is increasing in pregnant women in the USA and varies substantially by race. These trends provide valuable insight into the increasing complexity of pregnancy in the USA and explain a proportion of the observed increase in severe maternal morbidity/mortality.
近年来，美国孕产妇严重发病和死亡情况有所增加。这种趋势在所有种族群体中并不一致。其背后的原因，以及既往疾病、妊娠相关疾病与孕产妇严重发病/死亡之间的关系，尚未得到充分探讨。
1993年至2012年分娩住院的年度数据来自全国住院样本（NIS），该样本代表了美国各地20%的医院出院病例。采用趋势卡方检验来研究按产科合并症评分定义的合并症影响妊娠比例的时间模式，并按产妇种族进行分层。使用逻辑回归来确定合并症的时间增加对孕产妇严重发病/死亡的影响。
1993年，34.3%的妊娠合并症评分为≥1；到2012年，这一比例显著增至44.1%（p<0.001）。所有种族之间均观察到基线差异（白人33.7%，黑人34.5%，西班牙裔28.0%，亚裔/太平洋岛民28.1%）。尽管所有种族均有显著增加，但白人的相对变化率最低（增加26.1%），亚裔/太平洋岛民最高（增加49.1%）。孕产妇严重发病/死亡的几率随时间稳步增加；然而，对产科合并症评分进行调整后，这种相关性显著减弱。
美国孕妇中既往合并症和妊娠相关疾病的发生率均在上升，且因种族而异。这些趋势为美国妊娠日益增加的复杂性提供了有价值的见解，并解释了观察到的孕产妇严重发病/死亡增加的一部分原因。
