Hosier Hillary, Xu Xiao, Underwood Katherine, Ackerman-Banks Christina, Campbell Katherine H, Reddy Uma M
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
Am J Obstet Gynecol MFM. 2022 Nov;4(6):100708. doi: 10.1016/j.ajogmf.2022.100708. Epub 2022 Aug 11.
Despite growing evidence suggesting racial or ethnic disparities in the risk of severe maternal morbidity among live births, there is little research investigating potential differences in severe maternal morbidity risk among stillbirths across race and ethnicity.
This study aimed to compare the risk of severe maternal morbidity by race and ethnicity among patients with singleton stillbirth pregnancies.
We used the California Linked Birth File database to perform a retrospective analysis of singleton stillbirth pregnancies delivered at 20 to 42 weeks' gestation between 2007 and 2011. The database contained information from fetal death certificates linked to maternal hospital discharge records. We defined severe maternal morbidity using the Centers for Disease Control and Prevention composite severe maternal morbidity indicator and compared rates of severe maternal morbidity across racial and ethnic groups. Multivariable regression analysis was used to examine how race and ethnicity were associated with severe maternal morbidity risk after accounting for the influence of patients' clinical risk factors, socioeconomic characteristics, and attributes of the delivery hospital.
Of the 9198 patients with singleton stillbirths, 533 (5.8%) experienced severe maternal morbidity. Non-Hispanic Black patients had a significantly higher risk of severe maternal morbidity (10.6% vs 5.2% in non-Hispanic White patients, 5.2% in Hispanic patients, and 5.1% in patients with other race or ethnicity; P<.001). The higher risk of severe maternal morbidity among non-Hispanic Black patients persisted even after adjusting for patients' clinical, socioeconomic, and hospital characteristics (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.74; 95% confidence interval, 1.21-2.50). Further analysis separating blood-transfusion and nontransfusion severe maternal morbidity showed a higher risk of blood transfusion in non-Hispanic Black patients, which remained significant after adjusting for patients' clinical, socioeconomic, and hospital characteristics (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.64; 95% confidence interval, 1.11-2.43). However, the higher risk of nontransfusion severe maternal morbidity in non-Hispanic Black patients was no longer significant after adjusting for patients' clinical risk factors (adjusted odds ratio for non-Hispanic Black vs non-Hispanic White patients, 1.38; 95% confidence interval, 0.83-2.30).
Severe maternal morbidity occurred in 5.8% of patients with a singleton stillbirth. Risk of severe maternal morbidity in stillbirth was higher in patients with non-Hispanic Black race, which was likely owing to a higher risk of hemorrhage, as evidenced by increased rate of blood transfusion.
尽管越来越多的证据表明活产中严重孕产妇发病风险存在种族或民族差异，但关于死产中严重孕产妇发病风险在不同种族和民族间潜在差异的研究却很少。
本研究旨在比较单胎死产妊娠患者中不同种族和民族的严重孕产妇发病风险。
我们使用加利福尼亚州链接出生档案数据库，对2007年至2011年期间妊娠20至42周分娩的单胎死产妊娠进行回顾性分析。该数据库包含与孕产妇医院出院记录相关的胎儿死亡证明信息。我们使用疾病控制与预防中心的综合严重孕产妇发病指标来定义严重孕产妇发病，并比较不同种族和民族群体的严重孕产妇发病率。多变量回归分析用于检验在考虑患者临床风险因素、社会经济特征和分娩医院属性的影响后，种族和民族与严重孕产妇发病风险之间的关联。
在9198名单胎死产患者中，533例（5.8%）发生了严重孕产妇发病。非西班牙裔黑人患者发生严重孕产妇发病的风险显著更高（非西班牙裔白人患者为5.2%，西班牙裔患者为5.2%，其他种族或民族患者为5.1%，而非西班牙裔黑人患者为10.6%；P<0.001）。即使在对患者的临床、社会经济和医院特征进行调整后，非西班牙裔黑人患者中严重孕产妇发病的较高风险仍然存在（非西班牙裔黑人患者与非西班牙裔白人患者相比的调整优势比为1.74；95%置信区间为1.21 - 2.50）。进一步分析将输血相关和非输血相关的严重孕产妇发病分开，结果显示非西班牙裔黑人患者输血风险更高，在对患者的临床、社会经济和医院特征进行调整后，该风险仍然显著（非西班牙裔黑人患者与非西班牙裔白人患者相比的调整优势比为1.64；95%置信区间为1.11 - 2.43）。然而，在对患者的临床风险因素进行调整后，非西班牙裔黑人患者中非输血相关严重孕产妇发病的较高风险不再显著（非西班牙裔黑人患者与非西班牙裔白人患者相比的调整优势比为1.38；95%置信区间为0.83 - 2.30）。
单胎死产患者中5.8%发生了严重孕产妇发病。非西班牙裔黑人种族的死产患者中严重孕产妇发病风险更高，这可能是由于出血风险更高，输血率增加证明了这一点。
