智力和发育障碍妇女的严重产妇发病率和产妇死亡率。
Severe Maternal Morbidity and Maternal Mortality in Women With Intellectual and Developmental Disabilities.
机构信息
The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts.
The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts.
出版信息
Am J Prev Med. 2021 Dec;61(6):872-881. doi: 10.1016/j.amepre.2021.05.041. Epub 2021 Sep 25.
INTRODUCTION
Despite increased attention on severe maternal morbidity and maternal mortality, scant research exists on adverse maternal outcomes in women with disabilities. This study compares the rates of severe maternal morbidity and maternal mortality in women with and without intellectual and developmental disabilities.
METHODS
This study used 2004-2017 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Analyses were conducted in 2019‒2020. The risk of severe maternal morbidity with and without blood transfusion and maternal mortality during delivery among women with and without intellectual and developmental disabilities were compared using modified Poisson regression analysis.
RESULTS
This study identified 32,324 deliveries to women with intellectual and developmental disabilities. Per 10,000 deliveries, 566 deliveries with severe maternal morbidity occurred in women with intellectual and developmental disabilities compared with 239 in women without intellectual and developmental disabilities. Women with intellectual and developmental disabilities had greater risk of both severe maternal morbidity (risk ratio=2.36, 95% CI=2.06, 2.69) and nontransfusion severe maternal morbidity (risk ratio=2.95, 95% CI=2.42, 3.61) in unadjusted analyses, which was mitigated in adjusted analyses for sociodemographic characteristics (risk ratio=1.74, 95% CI=1.47, 2.06; risk ratio=1.85, 95% CI=1.42, 2.41) and the expanded obstetric comorbidity index (risk ratio=1.23, 95% CI=1.04, 1.44; risk ratio=1.31, 95% CI=1.02, 1.68). The unadjusted incidence of maternal mortality in women with intellectual and developmental disabilities was 284 per 100,000 deliveries, nearly 4-fold higher than in women without intellectual and developmental disabilities (69 per 100,000 deliveries; risk ratio=4.07, 95% CI=2.04, 8.12), and the risk remained almost 3-fold higher after adjustment for sociodemographic characteristics (risk ratio=2.86, 95% CI=1.30, 6.29) and the expanded obstetric comorbidity index (risk ratio=2.30, 95% CI=1.05, 5.29).
CONCLUSIONS
Women with intellectual and developmental disabilities are at increased risk of severe maternal morbidity and maternal mortality. These findings underscore the need for enhanced monitoring of the needs and maternal outcomes of women with intellectual and developmental disabilities in efforts to improve maternal health.
简介
尽管人们越来越关注严重产妇发病率和产妇死亡率，但关于残疾女性不良产妇结局的研究甚少。本研究比较了有智力和发育障碍的女性与无智力和发育障碍的女性发生严重产妇发病率和产妇死亡率的情况。
方法
本研究使用了 2004-2017 年医疗保健成本和利用项目全国住院患者样本数据。分析于 2019-2020 年进行。使用修正泊松回归分析比较了有和无智力和发育障碍的女性在分娩时发生严重产妇发病率（有无输血）和产妇死亡率的风险。
结果
本研究确定了 32324 例有智力和发育障碍的女性分娩。每 10000 例分娩中，有智力和发育障碍的女性中有 566 例发生严重产妇发病率，而无智力和发育障碍的女性中有 239 例。未经调整分析，有智力和发育障碍的女性发生严重产妇发病率（风险比=2.36，95%可信区间=2.06，2.69）和非输血严重产妇发病率（风险比=2.95，95%可信区间=2.42，3.61）的风险更高，在调整了社会人口统计学特征（风险比=1.74，95%可信区间=1.47，2.06；风险比=1.85，95%可信区间=1.42，2.41）和扩展产科合并症指数（风险比=1.23，95%可信区间=1.04，1.44；风险比=1.31，95%可信区间=1.02，1.68）后，这种风险有所缓解。未经调整，有智力和发育障碍的女性的产妇死亡率为每 100000 例分娩 284 例，几乎是无智力和发育障碍女性的 4 倍（每 100000 例分娩 69 例；风险比=4.07，95%可信区间=2.04，8.12），在调整了社会人口统计学特征（风险比=2.86，95%可信区间=1.30，6.29）和扩展产科合并症指数（风险比=2.30，95%可信区间=1.05，5.29）后，这种风险仍几乎高 3 倍。
结论
有智力和发育障碍的女性发生严重产妇发病率和产妇死亡率的风险增加。这些发现强调了需要加强对有智力和发育障碍的女性的需求和产妇结局的监测，以改善产妇健康。
Zotero 插件