Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, the Institut national de santé publique du Québec, the Departments of Medicine and Obstetrics and Gynecology, McGill University Health Centre, the Cardiology Service, University of Montreal Hospital Center, the University of Montreal Hospital Research Centre, and the Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
Obstet Gynecol. 2021 Feb 1;137(2):277-284. doi: 10.1097/AOG.0000000000004223.
To examine long-term risks of mortality after a pregnancy complicated by severe maternal morbidity.
We analyzed a longitudinal cohort of 1,229,306 women who delivered in the province of Quebec, Canada from 1989 through 2016. Severe maternal morbidity included conditions such as cerebrovascular accidents, acute renal failure, severe preeclampsia, and other life-threatening complications. The outcome was in-hospital mortality after the last pregnancy, categorized as postpartum (42 days or fewer after delivery) and long-term (43 days to 29 years after delivery). We estimated hazard ratios (HRs) ofr mortality with 95% CI for severe maternal morbidity compared with no severe morbidity, using Cox regression models adjusted for maternal characteristics.
Severe maternal morbidity occurred in 2.9% of women. The mortality rate associated with severe maternal morbidity was 0.86 per 1,000 person-years compared with 0.41 per 1,000 person-years for no morbidity. Compared with no morbidity, severe maternal morbidity was associated with two times the rate of death any time after delivery (95% CI 1.81-2.20). Severe cardiac complications (HR 7.00, 85% CI 4.94-9.91), acute renal failure (HR 4.35, 95% CI 2.66-7.10), and cerebrovascular accidents (HR 4.03, 95% CI 2.17-7.48) were the leading morbidities associated with mortality after 42 days.
Women who experience severe maternal morbidity have an accelerated risk of mortality beyond the postpartum period compared with women who do not experience severe morbidity. More intensive clinical follow-up may be merited for women with serious pregnancy complications.
研究严重孕产妇并发症后长期死亡风险。
我们分析了 1989 年至 2016 年期间在加拿大魁北克省分娩的 1,229,306 名妇女的纵向队列。严重孕产妇并发症包括脑血管意外、急性肾衰竭、严重子痫前期和其他危及生命的并发症等。结局是最后一次妊娠后的院内死亡率，分为产后（分娩后 42 天或更短时间）和长期（分娩后 43 天至 29 年）。我们使用 Cox 回归模型，根据产妇特征调整后，估计严重孕产妇并发症与无严重并发症相比的死亡率风险比（HR）及其 95%置信区间。
2.9%的妇女发生严重孕产妇并发症。严重孕产妇并发症相关的死亡率为 0.86/1000 人年，而无并发症的死亡率为 0.41/1000 人年。与无并发症相比，严重孕产妇并发症与分娩后任何时间的死亡风险增加两倍相关（95%CI 1.81-2.20）。严重心脏并发症（HR 7.00，95%CI 4.94-9.91）、急性肾衰竭（HR 4.35，95%CI 2.66-7.10）和脑血管意外（HR 4.03，95%CI 2.17-7.48）是 42 天后与死亡率相关的主要并发症。
与无严重并发症的妇女相比，经历严重孕产妇并发症的妇女在产后期间死亡率风险加速。对于有严重妊娠并发症的妇女，可能需要更强化的临床随访。
