Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montréal Quebec H3A 0G4, Canada; McGill University Health Center, 1001 Decarie Boulevard, Room D05.2519, Montreal QC H4A 3J1.
Faculty of Medicine, McGill University, Montréal Quebec H3G 2M1, Canada.
Reprod Biomed Online. 2020 Dec;41(6):1093-1099. doi: 10.1016/j.rbmo.2020.08.036. Epub 2020 Aug 29.
What is the association between congenital adrenal hyperplasia (CAH) and pregnancy, delivery and neonatal outcomes, using a population database cohort.
Retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database from 2004-2014. ICD-9 code 255.2 was used to extract the cases of CAH. Pregnancies complicated with CAH were compared with the other pregnancies. All confounding variables were adjusted using multivariate logistic regression, based on any significant differences between the two groups.
A total of 9,096,788 deliveries occurred during the study period. Two hundred and ninety-nine pregnant women had CAH. Chorioamnionitis was higher in CAH compared with controls after controlling for risk factors (adjusted OR 2.67, 95% CI 1.17 to 6.06). The rates of caesarean section and maternal infection were also higher in CAH than controls (adjusted OR 2.10, 95% CI 1.44 to 3.07 and adjusted OR 2.63, 95% CI 1.22 to 5.63, respectively). Risk of gestational diabetes and pregnancy-induced hypertension rates were not significantly different in CAH (adjusted OR 1.53, 95% CI 0.91 to 2.58 and adjusted OR 0.87, 95% CI 0.49 to 1.56, respectively). At birth, 8% and 2.2% of the neonates were found to be small for gestational age in the CAH and the control groups, respectively (adjusted OR 3.37, 95% CI 1.86 to 6.11). Congenital anomalies were encountered in 2.7% and 0.4% in the CAH and control groups, respectively (adjusted OR 5.24, 95% CI 2.31 to 11.90).
Women with CAH were at risk of complications and fetal anomalies. Expected increases in rates of hypertension and gestational diabetes were not encountered. These patients will benefit from surveillance to decrease morbidity.
使用人群数据库队列，研究先天性肾上腺增生症（CAH）与妊娠、分娩和新生儿结局之间的关联。
使用 2004-2014 年医疗保健成本和利用项目-全国住院患者样本数据库进行回顾性研究。使用 ICD-9 代码 255.2 提取 CAH 病例。将合并 CAH 的妊娠与其他妊娠进行比较。根据两组之间的任何显著差异，使用多变量逻辑回归调整所有混杂变量。
在研究期间，共发生了 9096788 次分娩。299 名孕妇患有 CAH。在控制了危险因素后，CAH 组绒毛膜羊膜炎的发生率高于对照组（调整后的 OR 2.67，95%CI 1.17-6.06）。CAH 组剖宫产和产妇感染的发生率也高于对照组（调整后的 OR 2.10，95%CI 1.44-3.07 和调整后的 OR 2.63，95%CI 1.22-5.63，分别）。CAH 组妊娠期糖尿病和妊娠高血压的发生率无显著差异（调整后的 OR 1.53，95%CI 0.91-2.58 和调整后的 OR 0.87，95%CI 0.49-1.56，分别）。在出生时，CAH 组和对照组中分别有 8%和 2.2%的新生儿被认为是小于胎龄儿（调整后的 OR 3.37，95%CI 1.86-6.11）。CAH 组和对照组分别有 2.7%和 0.4%的新生儿存在先天性异常（调整后的 OR 5.24，95%CI 2.31-11.90）。
患有 CAH 的女性存在并发症和胎儿异常的风险。预期的高血压和妊娠期糖尿病发生率增加并未出现。这些患者将受益于监测以降低发病率。
