Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Am J Obstet Gynecol MFM. 2020 Nov;2(4):100181. doi: 10.1016/j.ajogmf.2020.100181. Epub 2020 Jul 22.
Preeclampsia complicates 5% to 8% of all pregnancies. Previous studies have examined the maternal morbidity and mortality associated with preeclampsia and the expectant management of severe preterm preeclampsia. However, these studies either did not comment on outcomes by race or were primarily made up of nonblack participants.
This study aimed to determine whether maternal morbidity associated with the expectant management of severe preterm preeclampsia varied by race.
We performed a retrospective cohort study of women with a diagnosis of severe preterm preeclampsia at <34 weeks' gestation between 2008 and 2017 at our institution. Severe preterm preeclampsia was defined by current American College of Obstetricians and Gynecologists guidelines. The primary outcome was a maternal morbidity composite, defined as experiencing ≥1 of the following: hemolysis, elevated liver enzymes, and low platelet count; eclampsia; pulmonary edema; severe renal dysfunction; abruption; maternal intensive care unit admission; venous thromboembolism; blood transfusion; hysterectomy; stroke; or death. Secondary outcomes included a composite of neonatal morbidity. Outcomes were compared between self-reported black and nonblack women.
In this study, 275 women were included; among those women, 91 (33%) were nonblack, and 184 (67%) were black. In addition, 203 of 275 women (approximately 74%) underwent expectant management with no difference by race (75.8% of nonblack vs 72.8% of black women; P=.6). When examining maternal morbidity, 62 of the expectantly managed women (30.5%) developed the composite maternal morbidity outcome, with no difference by race (27.5% of nonblack vs 32.1% of black women; P=.5) even when adjusting for confounders such as maternal age, body mass index, and parity (adjusted odds ratio, 1.02; 95% confidence interval, 0.97-1.35). The median time from diagnosis to delivery (latency time) was 3 days, with no difference between the 2 groups (P=.9) and no difference in neonatal morbidity (60.9% nonblack vs 53% black; P=.3).
Within our population, there were no differences in maternal outcomes between black and nonblack women who were undergoing expectant management of severe preterm preeclampsia. More research is needed to determine if the known disparities in maternal morbidity among races are due to factors beyond the antepartum management of severe preterm preeclampsia.
子痫前期影响所有妊娠的 5%至 8%。既往研究已评估了与子痫前期相关的孕产妇发病率和死亡率，以及严重早产子痫前期的期待治疗。然而，这些研究要么没有按种族评论结局，要么主要由非黑人参与者组成。
本研究旨在确定严重早产子痫前期期待治疗相关的孕产妇发病率是否因种族而异。
我们对 2008 年至 2017 年期间在我院诊断为严重早产子痫前期且胎龄<34 周的女性进行了回顾性队列研究。严重早产子痫前期的定义采用现行美国妇产科医师学会的指南。主要结局为发生以下至少 1 种情况的孕产妇发病率复合结局：溶血、肝酶升高和血小板计数降低；子痫；肺水肿；严重肾功能不全；胎盘早剥；入住重症监护病房；静脉血栓栓塞；输血；子宫切除术；中风；或死亡。次要结局包括新生儿发病率复合结局。比较自我报告的黑人与非黑人女性的结局。
本研究纳入了 275 名女性；其中 91 名（33%）为非黑人，184 名（67%）为黑人。此外，275 名女性中有 203 名（约 74%）接受期待治疗，种族间无差异（非黑人占 75.8%，黑人占 72.8%；P=.6）。在评估孕产妇发病率时，62 名接受期待治疗的女性（30.5%）发生了复合结局，种族间无差异（非黑人占 27.5%，黑人占 32.1%；P=.5），即使在调整了孕产妇年龄、体重指数和产次等混杂因素后也是如此（校正优势比，1.02；95%置信区间，0.97-1.35）。从诊断到分娩的中位时间（潜伏期）为 3 天，两组间无差异（P=.9），新生儿发病率也无差异（非黑人占 60.9%，黑人占 53%；P=.3）。
在我们的人群中，黑人与非黑人女性在接受严重早产子痫前期期待治疗时，其孕产妇结局无差异。需要进一步研究来确定种族间已知的孕产妇发病率差异是否归因于严重早产子痫前期的产前管理以外的因素。
