Bornstein Eran, Eliner Yael, Chervenak Frank A, Grünebaum Amos
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Northwell Health/Zucker School of Medicine, New York, NY, United States.
Boston University, School of Public Health, Boston, MA, United States.
EClinicalMedicine. 2020 Nov 20;29-30:100657. doi: 10.1016/j.eclinm.2020.100657. eCollection 2020 Dec.
Increased efforts have focused on reducing maternal morbidity and mortality in the United States (US). Hypertensive disorders of pregnancy, chronic hypertension, diabetes mellitus, very advanced maternal age, and grand multiparity are known contributors to various maternal morbidities, as well as maternal mortality. We aimed to evaluate the trends in these risk factors/complications among US pregnancies during the last three decades (1989-2018).
This is a retrospective study based on the CDC natality database. We calculated the annual prevalence of each risk factor/complication from 1989 to 2018. Joinpoint regression analysis was then used to evaluate the trends. Annual percentage changes (APC) were calculated for each of the segments identified by the joinpoint regression, and average annual percentage changes (AAPC) were calculated for the entire period. Relative risks (RR) comparing the prevalence of each risk factor/complication in 2018 to its prevalence in 1989 were also calculated. Subsequent analyses evaluated the trends of the main risk factors/complications by maternal age groups. Statistical significance was determined at <0·05, and results were presented with 95% confidence intervals.
Between 1989 and 2018, the prevalence of hypertensive disorders of pregnancy increased by 149% (AAPC 3·2, 95% CI 2·6-3·8), that of chronic hypertension increased by 182% (AAPC 3·7, 95% CI 3·3-4·2), that of diabetes mellitus increased by 261% (AAPC 4·6, 95% CI 4·0-5·2), that of very advanced maternal age increased by 194% (AAPC 3·8, 95% CI 3·6-4·0), and that of grand multiparity increased by 33% (AAPC 1·0, 95% CI 0·8-1·2). Chronic hypertension and diabetes mellitus increased mostly during the past two decades, while hypertensive disorders of pregnancy and grand multiparity increased primarily over the most recent decade. Additionally, women of very advanced maternal age had significantly higher rates of hypertensive disorders of pregnancy, chronic hypertension and diabetes mellitus throughout our study period.
Our study shows a marked increase in the prevalence of five pregnancy risk factors/complications over the past three decades (1989-2018). This may point to a significant deterioration in the health of US pregnant women, which potentially contributes to both maternal morbidity and mortality.
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美国已加大力度致力于降低孕产妇发病率和死亡率。妊娠高血压疾病、慢性高血压、糖尿病、高龄孕产妇以及多产是导致各种孕产妇发病和死亡的已知因素。我们旨在评估过去三十年（1989 - 2018年）美国妊娠期间这些风险因素/并发症的趋势。
这是一项基于美国疾病控制与预防中心出生数据库的回顾性研究。我们计算了1989年至2018年各风险因素/并发症的年患病率。然后采用连接点回归分析来评估趋势。计算连接点回归确定的每个时间段的年变化百分比（APC），并计算整个时期的平均年变化百分比（AAPC）。还计算了2018年各风险因素/并发症患病率与1989年患病率相比的相对风险（RR）。后续分析按孕产妇年龄组评估主要风险因素/并发症的趋势。以<0·05为统计学显著性水平，结果以95%置信区间呈现。
1989年至2018年期间，妊娠高血压疾病患病率增加了149%（AAPC 3·2，95% CI 2·6 - 3·8），慢性高血压患病率增加了182%（AAPC 3·7，95% CI 3·3 - 4·2），糖尿病患病率增加了261%（AAPC 4·6，95% CI 4·0 - 5·2），高龄孕产妇患病率增加了194%（AAPC 3·8，95% CI 3·6 - 4·0），多产患病率增加了33%（AAPC 1·0，95% CI 0·8 - 1·2）。慢性高血压和糖尿病主要在过去二十年中增加，而妊娠高血压疾病和多产主要在最近十年中增加。此外，在我们整个研究期间，高龄孕产妇患妊娠高血压疾病、慢性高血压和糖尿病的比例显著更高。
我们的研究表明，在过去三十年（1989 - 2018年）中，五种妊娠风险因素/并发症的患病率显著增加。这可能表明美国孕妇的健康状况显著恶化，这可能导致孕产妇发病和死亡。
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