2003 年至 2018 年韩国分娩产妇严重产妇发病率全球指标比较：基于人群的回顾性队列研究。
Comparison of global indicators for severe maternal morbidity among South Korean women who delivered from 2003 to 2018: a population-based retrospective cohort study.
机构信息
Department of Healthcare Management, Eulji University, Sanseongdae-ro 553, Sujeong-gu, Seongnam, Gyeonggi-do, 13135, Republic of Korea.
出版信息
Reprod Health. 2022 Aug 13;19(1):177. doi: 10.1186/s12978-022-01482-y.
BACKGROUND
Even though several severe maternal morbidity (SMM) indicators exist globally, indicators that can serve as international standards are needed. Therefore, this study aimed to compare the SMM risk assessment using four international indicators and identify the factors underlying the differences among the risk assessments obtained by the various indicators.
METHODS
This study used the National Health Insurance delivery cohort in South Korea from 2003 to 2018. SMM was estimated using four indicators: the United States Centers for Disease Control and Prevention (US-CDC) SMM algorithm, the American College of Obstetricians and Gynecologists (ACOG) gold standard guidelines, Zwart et al.'s indicators for the Netherlands, and the European Network on Severe Acute Maternal Morbidity (EURONET-SAMM) index. Generalized estimating equations models were used to identify the relationships between SMM indicators and risk factors.
RESULTS
The SMM incidence rates in 6,421,091 deliveries, were 2.36%, 3.12%, 0.31%, and 1.36% using the US-CDC, ACOG, Zwart et al.'s, and EURONET SAMM indicators, respectively. In sub indicators, hemorrhage-related codes constituted the highest proportion of all SMM indicators. Advanced maternal age was related to high risk in all four SMM indicators (US-CDC: 40-44 years, RR 1.67, 95% CI 1.63-1.71; ACOG's guidelines: 40-44 years, RR 1.52, 95% CI 1.49-1.56; Zwart's indicators: RR 2.72, 95% CI 2.55-2.90; EURONET-SAMM: RR 2.04, 95% CI 1.97-2.11) compared to those aged 25-29 years. In residential area, women who lived in rural area had approximately 1.2- to 1.5-fold higher risk of SMM compared to those who lived in Seoul. Additionally, inadequate prenatal care was associated with a 1.1- to 1.4-fold higher risk of SMM compared to adequate prenatal care.
CONCLUSIONS
SMM was associated with maternal age, socioeconomic status, and adverse obstetric factors using various international SMM indicators. Further studies are needed to further determine risk and preventable factors for SMM and to identify more specific causes associated with the frequent sub-indicators of SMM.
背景
尽管全球有几个严重产妇发病率（SMM）指标，但需要能够作为国际标准的指标。因此，本研究旨在比较使用四个国际指标评估 SMM 的风险，并确定各种指标得出的风险评估之间差异的基础因素。
方法
本研究使用了韩国 2003 年至 2018 年的国家健康保险分娩队列。使用四个指标估计 SMM：美国疾病控制与预防中心（US-CDC）SMM 算法、美国妇产科医师学会（ACOG）黄金标准指南、Zwart 等人的荷兰指标和欧洲严重急性产妇发病率网络（EURONET-SAMM）指数。使用广义估计方程模型确定 SMM 指标与危险因素之间的关系。
结果
在 6421091 次分娩中，使用 US-CDC、ACOG、Zwart 等人的和 EURONET-SAMM 指标的 SMM 发生率分别为 2.36%、3.12%、0.31%和 1.36%。在子指标中，与出血相关的代码构成了所有 SMM 指标中最高的比例。高龄产妇在所有四个 SMM 指标中都与高风险相关（US-CDC：40-44 岁，RR 1.67，95%CI 1.63-1.71；ACOG 的指南：40-44 岁，RR 1.52，95%CI 1.49-1.56；Zwart 的指标：RR 2.72，95%CI 2.55-2.90；EURONET-SAMM：RR 2.04，95%CI 1.97-2.11），与 25-29 岁的产妇相比。在居住地区方面，与居住在首尔的产妇相比，居住在农村地区的产妇 SMM 风险约高 1.2-1.5 倍。此外，与适当的产前护理相比，产前护理不足与 SMM 的风险增加 1.1-1.4 倍相关。
结论
使用各种国际 SMM 指标，SMM 与产妇年龄、社会经济地位和不良产科因素相关。需要进一步研究以进一步确定 SMM 的风险和可预防因素，并确定与 SMM 常见子指标相关的更具体原因。
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