Department of Obstetrics and Gynecology, the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and the Department of Anesthesiology, Columbia University, New York, New York; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
Obstet Gynecol. 2022 Jan 1;139(1):52-62. doi: 10.1097/AOG.0000000000004635.
To characterize asthma prevalence and outcomes during U.S. delivery hospitalizations.
For this repeated cross-sectional analysis, deliveries to women aged 15-54 years with asthma were identified in the 2000-2018 National Inpatient Sample, which approximates a 20% stratified sample of all hospitalizations nationally. Temporal trends in asthma were analyzed using joinpoint regression to estimate the average annual percent change with 95% CIs. The association of asthma with other comorbid conditions was analyzed. The relationship between asthma and several adverse maternal outcomes was analyzed with unadjusted and adjusted logistic regression models, with unadjusted odds ratios and adjusted odds ratios (aORs) as measures of effect. Risk for and trends in a composite of rare, but severe, respiratory complications also were analyzed.
An estimated 73,109,790 delivery hospitalizations from 2000 to 2018 were included in the analysis, of which 2,221,644 (3.0%) had a diagnosis of asthma. (Unweighted, the study sample included 15,213,024 deliveries, of which 462,276 [3.0%] had a diagnosis of asthma.) Asthma diagnoses rose from 1.2% in 2000 to 5.3% in 2018, representing an average annual percent change of 8.3% (95% CI 7.4-9.2%). Asthma was more common among women with obesity and chronic hypertension. In adjusted analyses, asthma was associated with severe maternal morbidity (aOR 1.50, 95% CI 1.45-1.55), preeclampsia and gestational hypertension (aOR 1.29, 95% CI 1.26-1.30), postpartum hemorrhage (aOR 1.21, 95% CI 1.19-1.24), cesarean delivery (aOR 1.16, 95% CI 1.15-1.18), gestational diabetes (aOR 1.20, 95% CI 1.18-1.21), venous thromboembolism (aOR 1.79, 95% CI 1.65-1.95), and preterm delivery (aOR 1.27, 95% CI 1.25-1.29). From 2000 to 2018, severe respiratory complications decreased from 72 per 10,000 deliveries with asthma to 14 per 10,000 deliveries with asthma (average annual percent change -9.4%, 95% CI -13.3% to -5.3%). This decreasing risk was offset on a population level by an increase in the risk of asthma.
Asthma is increasing during deliveries, is associated with adverse maternal outcomes, and is associated with comorbid conditions. Severe respiratory complications are decreasing proportionately among deliveries with asthma, but are stable on a population basis.
描述美国分娩住院期间哮喘的流行情况和结局。
在这项重复的横断面分析中，在 2000 年至 2018 年的全国住院患者样本中确定了 15-54 岁患有哮喘的女性的分娩情况，该样本近似于全国所有住院患者的 20%分层样本。使用连接点回归分析哮喘的时间趋势，以估计平均年百分比变化及其 95%置信区间。分析哮喘与其他合并症的关系。使用未调整和调整后的逻辑回归模型分析哮喘与几种不良母婴结局的关系，未调整的优势比和调整后的优势比（aOR）作为效应的衡量指标。还分析了罕见但严重的呼吸并发症综合情况的风险和趋势。
在 2000 年至 2018 年期间，共纳入了估计 7310.979 万次分娩住院的分析，其中 222.1644 次（3.0%）有哮喘诊断。（未加权，研究样本包括 1521.3024 次分娩，其中 462276 次[3.0%]有哮喘诊断。）哮喘诊断从 2000 年的 1.2%上升到 2018 年的 5.3%，平均年百分比变化为 8.3%（95%CI 7.4-9.2%）。哮喘在肥胖和慢性高血压的女性中更为常见。在调整分析中，哮喘与严重产妇发病率（aOR 1.50，95%CI 1.45-1.55）、子痫前期和妊娠期高血压（aOR 1.29，95%CI 1.26-1.30）、产后出血（aOR 1.21，95%CI 1.19-1.24）、剖宫产（aOR 1.16，95%CI 1.15-1.18）、妊娠期糖尿病（aOR 1.20，95%CI 1.18-1.21）、静脉血栓栓塞症（aOR 1.79，95%CI 1.65-1.95）和早产（aOR 1.27，95%CI 1.25-1.29）相关。从 2000 年到 2018 年，哮喘患者严重呼吸并发症从每 10000 次分娩 72 例下降到每 10000 次分娩 14 例（平均年百分比变化-9.4%，95%CI-13.3%至-5.3%）。在人群水平上，哮喘风险的增加抵消了这一风险的降低。
哮喘在分娩期间呈上升趋势，与不良母婴结局有关，并与合并症有关。哮喘分娩的严重呼吸并发症比例下降，但在人群基础上保持稳定。
