Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT (Dr Bruno, Ms Allshouse, and Drs Metz and Theilen); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Murray, UT (Drs Bruno, Metz, and Theilen).
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT (Dr Bruno, Ms Allshouse, and Drs Metz and Theilen).
Am J Obstet Gynecol MFM. 2023 Apr;5(4):100877. doi: 10.1016/j.ajogmf.2023.100877. Epub 2023 Jan 25.
The US Preventive Services Taskforce published guidelines in 2014 recommending that low-dose aspirin be initiated between 12 and 28 weeks of gestation among high-risk patients for preeclampsia prophylaxis. Moreover, low-dose aspirin is recommended by some clinicians for the prevention of preterm birth.
This study aimed to evaluate whether there is an association between the US Preventive Services Taskforce aspirin guideline hypertensive disorders of pregnancy and the rates of hypertensive disorders of pregnancy and preterm birth in individuals with pregestational diabetes mellitus.
This was a repeated cross-sectional analysis of individuals with pregestational diabetes mellitus and at least 1 singleton delivery at >20 weeks of gestation with records available in the National Vital Statistics System between 2010 and 2018. The primary outcome was hypertensive disorders of pregnancy, and the secondary outcome was preterm birth. Demographics and clinical characteristics among individuals in the pre-US Preventive Services Taskforce guideline cohort (2010-2013) were compared with that of individuals in the post-US Preventive Services Taskforce guideline cohort (2015-2018). Multivariable regression estimated the odds ratios and 95% confidence intervals for the association between guideline publication and the selected endpoints. Effect modification was assessed for access to prenatal care using the Kotelchuck Index (<80% vs ≥80%). Furthermore, a sensitivity analysis limited to nulliparas was performed.
Overall, 224,065 individuals were included. Individuals in the post-US Preventive Services Taskforce guideline cohort were more likely to be older, be obese, and have a history of preterm birth. In unadjusted and adjusted modeling, delivery in the post-US Preventive Services Taskforce guideline cohort was associated with hypertensive disorders of pregnancy (adjusted odds ratio, 1.25; 95% confidence interval, 1.22-1.28) and preterm birth (adjusted odds ratio, 1.10; 95% confidence interval, 1.08-1.12). The adjusted odds ratios for hypertensive disorders of pregnancy and preterm birth were more pronounced among those with less than adequate access to care. The findings were similar in the sensitivity analysis of only nulliparas.
Delivery after US Preventive Services Taskforce aspirin guideline publication was associated with higher rates of hypertensive disorders of pregnancy and preterm birth in a population of individuals with diabetes mellitus. It is unknown whether patient or practitioner factors, or other changes in obstetrical care, contributed to these findings.
美国预防服务工作组于 2014 年发布指南，建议高危子痫前期预防患者在妊娠 12-28 周时开始使用低剂量阿司匹林。此外，一些临床医生建议使用低剂量阿司匹林预防早产。
本研究旨在评估美国预防服务工作组（USPSTF）阿司匹林指南中妊娠高血压疾病与子痫前期糖尿病患者妊娠高血压疾病和早产率之间是否存在关联。
这是一项针对 2010 年至 2018 年全国生命统计系统中至少有一次单胎妊娠 20 周以上记录的妊娠前糖尿病患者的重复横断面分析。主要结局是妊娠高血压疾病，次要结局是早产。比较 US Preventive Services Taskforce 指南前队列（2010-2013 年）和 US Preventive Services Taskforce 指南后队列（2015-2018 年）中个体的人口统计学和临床特征。多变量回归估计了指南发布与选定结局之间的比值比和 95%置信区间。使用 Kotelchuck 指数（<80%与≥80%）评估了产前保健获取的效果修饰。此外，还进行了仅限于初产妇的敏感性分析。
共有 224065 名患者入组。US Preventive Services Taskforce 指南后队列的患者年龄更大、更肥胖且有早产史。在未调整和调整后的模型中，US Preventive Services Taskforce 指南后队列的分娩与妊娠高血压疾病（调整比值比，1.25；95%置信区间，1.22-1.28）和早产（调整比值比，1.10；95%置信区间，1.08-1.12）相关。在产前保健服务获取不足的患者中，妊娠高血压疾病和早产的调整比值比更为明显。仅初产妇的敏感性分析结果相似。
在美国预防服务工作组阿司匹林指南发布后分娩与糖尿病患者妊娠高血压疾病和早产率升高相关。尚不清楚是患者或医生的因素还是产科护理的其他变化导致了这些发现。
