Booker Whitney A, Ananth Cande V, Wright Jason D, Siddiq Zainab, D'Alton Mary E, Cleary Kirstin L, Goffman Dena, Friedman Alexander M
a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA.
b Department of Epidemiology , Joseph L. Mailman School of Public Health, Columbia University , New York , NY , USA.
J Matern Fetal Neonatal Med. 2019 Aug;32(16):2680-2687. doi: 10.1080/14767058.2018.1446077. Epub 2018 Mar 12.
The objective of this study was to characterize morbidity, acuity, and maternal risks associated with preeclampsia across hospitals with varying obstetric volumes.
This retrospective cohort analysis used a large administrative data source, the Perspective database, to characterize the risk for preeclampsia from 2006 to 2015. Hospitals were classified as having either low (≤1000), moderate (1001-2000), or high (≥2000) delivery volume. The primary outcomes included preeclampsia, antihypertensive administration, comorbidity, and related severe maternal morbidity. Severe maternal morbidity was estimated using criteria from the Centers for Disease Control and Prevention. Comorbidity was estimated using an obstetric comorbidity index. Univariable comparisons were made with Chi-squared test. Adjusted log linear regression models were fit to assess factors associated with severe morbidity with risk ratios with 95% confidence intervals as the measures of effect. Population weights were applied to create national estimates.
Of 36,985,729 deliveries included, 1,414,484 (3.8%) had a diagnosis of preeclampsia. Of these, 779,511 (2.1%) had mild, 171,109 (0.5%) superimposed, and 463,864 (1.3%) severe preeclampsia. The prevalence of mild, superimposed, and severe preeclampsia each increased over the study period with severe and superimposed preeclampsia as opposed to mild preeclampsia increasing the most proportionately (53.2 and 102.5 versus 10.8%, respectively). The use of antihypertensives used to treat severe range hypertension increased with use of intravenous labetalol increasing 31.5%, 43.2%, and 36.1% at low-, medium-, and high-volume hospitals. Comorbid risk also increased across hospital volume settings as did risk for severe maternal morbidity.
Preeclampsia is increasing across obstetric care settings with preeclamptic patients demonstrating increasing comorbid risk, increased risk for severe morbidity, and more frequent need for treatment of acute hypertension.
本研究的目的是描述不同产科工作量医院中与子痫前期相关的发病率、严重程度及孕产妇风险。
这项回顾性队列分析使用了一个大型管理数据源——Perspective数据库，以描述2006年至2015年子痫前期的风险。医院被分类为低（≤1000例）、中（1001 - 2000例）或高（≥2000例）分娩量。主要结局包括子痫前期、抗高血压药物使用、合并症以及相关的严重孕产妇发病率。严重孕产妇发病率采用美国疾病控制与预防中心的标准进行评估。合并症采用产科合并症指数进行评估。采用卡方检验进行单变量比较。拟合调整后的对数线性回归模型，以评估与严重发病率相关的因素，并以风险比及95%置信区间作为效应量度。应用总体权重以得出全国估计值。
在纳入的36,985,729例分娩中，1,414,484例（3.8%）被诊断为子痫前期。其中，779,511例（2.1%）为轻度子痫前期，171,109例（0.5%）为叠加子痫前期，463,864例（1.3%）为重度子痫前期。在研究期间，轻度、叠加及重度子痫前期的患病率均有所上升，其中重度和叠加子痫前期相较于轻度子痫前期上升比例最大（分别为53.2%和102.5%，而轻度子痫前期为10.8%）。用于治疗重度高血压的抗高血压药物使用量增加，低、中、高分娩量医院静脉注射拉贝洛尔的使用量分别增加了31.5%、43.2%和36.1%。合并症风险以及严重孕产妇发病风险在不同分娩量医院中也均有所增加。
在产科护理环境中，子痫前期的发病率在上升，子痫前期患者的合并症风险增加，严重发病风险增加，且急性高血压治疗需求更为频繁。
