From the Department of Epidemiology, Brown University, Providence, RI.
Department of Obstetrics and Gynecology, Brown University, Providence, RI.
Epidemiology. 2022 Mar 1;33(2):260-268. doi: 10.1097/EDE.0000000000001442.
Clinicians caring for the nearly 10% of patients in the United States with nonsevere hypertensive disorders in late pregnancy need better evidence to balance risks and benefits of clinician-initiated delivery.
We conducted a record-based cohort study of maternal and infant health outcomes among deliveries from 2002-2013 at Women & Infants Hospital of Rhode Island. Participants had gestational hypertension or nonsevere preeclampsia before 39 weeks' gestation (N=4,295). For each gestational week from 34 to 38, we compared outcomes between clinician-initiated deliveries (induction of labor or prelabor cesarean) and those not initiated in that week, using propensity score models to control confounding by indication.
The analysis predicted an increment in risk of adverse maternal and infant outcomes sustained through week 37 if all patients underwent clinician-initiated delivery, with risk differences on the order of 0.2 for maternal outcomes and 0.3 for infant outcomes weeks 34 and 35. For women undergoing clinician-initiated delivery, the analysis identified increased risk of progression to severe disease in weeks 35 and 36, increases in all adverse infant outcomes only in week 34, increases in Neonatal Intensive Care Unit admission and infant hospital stay in weeks 35 and 36, and no meaningful increase in any of the adverse outcomes in weeks 37 or 38.
We estimate that hypertensive pregnancies chosen for intervention were minimally harmed by early delivery after 34 weeks' gestation but predict benefit from extension to 37 weeks. Our study also showed adverse infant health consequences associated with routine delivery prior to 37 weeks.
在美国，近 10%的妊娠晚期存在非重度高血压疾病的患者需要临床医生进行干预，对于这些患者，临床医生需要更好的证据来平衡分娩干预的风险和获益。
我们对 2002 年至 2013 年罗德岛妇女与婴儿医院的产妇和婴儿健康结局进行了基于记录的队列研究。参与者在妊娠 39 周前患有妊娠期高血压或非重度子痫前期（N=4295）。对于从 34 周到 38 周的每一周，我们比较了在该周内启动临床医生干预的分娩（引产或计划性剖宫产）与未启动的分娩之间的结局，使用倾向评分模型控制指示性混杂因素。
分析预测，如果所有患者都接受临床医生干预分娩，从第 34 周到第 37 周，不良母婴结局的风险会持续增加，风险差异在母体结局为 0.2，婴儿结局为 0.3。对于接受临床医生干预分娩的女性，分析发现第 35 周和第 36 周疾病进展为重度的风险增加，仅在第 34 周所有不良婴儿结局增加，第 35 周和第 36 周新生儿重症监护病房入院和婴儿住院时间增加，而在第 37 周或第 38 周，任何不良结局均无明显增加。
我们估计，妊娠高血压选择在 34 周后进行早期分娩干预的患者受到的伤害最小，但预测延长至 37 周会有获益。我们的研究还显示，在 37 周前常规分娩与婴儿健康不良后果相关。
