Obstetrics & Gynecology Department, Division of Maternal-Fetal Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Obstetrics & Gynecology, McGill University, Montreal, Quebec, Canada.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):6236-6242. doi: 10.1080/14767058.2021.1910658. Epub 2021 Aug 29.
The purpose of this study to evaluate the risk of Cushing's syndrome (CS) and maternal and fetal complications using the American Nationwide Inpatient Sample database.
This is a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database from 2004 to 2014. We compared pregnancies with CS versus non-CS regarding pregnancy, delivery, and neonatal outcomes using multivariate logistic regression.
We identified 9,096,788 pregnancies during the study period. Cushing's syndrome complicated 135 pregnancies at a rate of 1-2 cases per 100,000 births. Cushing's syndrome subjects were more likely to be older, obese, have private insurance, chronic hypertension, and pre-gestational diabetes (<.001). The maternal mortality rate was 0.7 and 0.007% in Cushing's syndrome and control groups, respectively, although due to small numbers of cases, this should be interpreted with caution. Preeclampsia was higher in CS compared to controls after controlling for confounding variables, aOR 2.20. Operative vaginal delivery and blood transfusion rates were higher in CS patients than controls after controlling for confounding factors, aOR 6.49 and 3.09, respectively. The rates of preterm delivery (8.9 versus 7.2%) and gestational diabetes (8.1 versus 5.8%) were not statistically different between CS and control groups.
Cushing's syndrome patients begin pregnancies often with maladies making them more at risk for complications including, preeclampsia, blood transfusion, and operative vaginal delivery. These patients might benefit from prevention methods for preeclampsia, and increased surveillance to decrease maternal morbidity and mortality. However, the nature of the database and its limitations, including the lack of information about CS activity and treatments received by patients, warrant careful interpretation of these results.
本研究旨在利用美国全国住院患者样本数据库评估库欣综合征（CS）和母婴并发症的风险。
这是一项使用 2004 年至 2014 年期间医疗保健成本和利用项目-全国住院患者样本数据库进行的回顾性研究。我们使用多变量逻辑回归比较了 CS 组与非 CS 组的妊娠、分娩和新生儿结局。
我们在研究期间共确定了 9096788 例妊娠。CS 并发症发生率为 1-2 例/10 万例，共有 135 例妊娠。CS 组患者年龄较大、肥胖、有私人保险、慢性高血压和孕前糖尿病的比例更高（<0.001）。CS 组和对照组的产妇死亡率分别为 0.7%和 0.007%，但由于病例数较少，应谨慎解释。在控制混杂因素后，CS 组的子痫前期发生率高于对照组，校正后的优势比为 2.20。在控制混杂因素后，CS 组的阴道分娩和输血率高于对照组，校正后的优势比分别为 6.49 和 3.09。CS 组和对照组的早产率（8.9%与 7.2%）和妊娠期糖尿病发生率（8.1%与 5.8%）无统计学差异。
CS 患者在开始妊娠时常常存在导致其更容易发生并发症的疾病，包括子痫前期、输血和阴道分娩。这些患者可能受益于子痫前期预防方法，以及增加监测以降低产妇发病率和死亡率。然而，数据库的性质及其局限性，包括缺乏有关 CS 活动和患者接受治疗的信息，需要对这些结果进行仔细解释。
