Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
J Matern Fetal Neonatal Med. 2023 Dec;36(1):2170748. doi: 10.1080/14767058.2023.2170748.
Severe hypercalcemia resulting from hyperparathyroidism may result in adverse perinatal outcomes. The objective of this study was to evaluate maternal and neonatal outcomes among pregnant women with hyperparathyroidism using a population database.
A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1999-2015. ICD-9 codes were used to identify women diagnosed with hyperparathyroidism during pregnancy. Perinatal outcomes between pregnant women with and without hyperparathyroidism were compared. Multivariate logistic regression, controlling for age, race, income, insurance type, hospital location, and comorbidities, evaluated the effect of hyperparathyroidism on perinatal outcomes.
Of 13,792,544 deliveries included over the study period, 368 were to women with hyperparathyroidism. The overall incidence of hyperparathyroidism was 2.7/100,000 births, increasing from 1.6 to 5.2/100,000 births over the study period ( < 0.0001). Women with hyperparathyroidism were older and had more comorbidities, such as obesity, and pre-gestational hypertension and diabetes. Relative to the comparison group, women with hyperparathyroidism were more likely to deliver preterm, OR 1.69 (95% CI 1.24-2.29), to develop preeclampsia, 3.14 (2.30-4.28), and to deliver by cesarean, 1.69 (1.36-2.09). Infants born to mothers with hyperparathyroidism were more likely to be growth restricted, 1.83 (1.08-3.07), and to be diagnosed with a congenital anomaly, 4.21 (2.09-8.48).
Hyperparathyroidism during pregnancy is associated with a significant increase in adverse perinatal outcomes, including preeclampsia, preterm delivery, fetal growth restriction, and congenital anomalies. As such, pregnancies among women with hyperparathyroidism should be considered high-risk, and specialized care is recommended in order to minimize maternal and neonatal morbidity.
甲状旁腺功能亢进导致的严重高钙血症可能导致不良围产期结局。本研究的目的是使用人群数据库评估甲状旁腺功能亢进孕妇的母婴结局。
采用 1999 年至 2015 年医疗保健成本和利用项目全国住院患者样本中的回顾性队列研究。使用 ICD-9 代码来识别在怀孕期间被诊断为甲状旁腺功能亢进的女性。比较甲状旁腺功能亢进孕妇和非甲状旁腺功能亢进孕妇的围产期结局。多变量逻辑回归，控制年龄、种族、收入、保险类型、医院位置和合并症，评估甲状旁腺功能亢进对围产期结局的影响。
在研究期间纳入的 13792544 例分娩中，有 368 例是甲状旁腺功能亢进孕妇。甲状旁腺功能亢进的总体发生率为 2.7/100000 次分娩，研究期间从 1.6 增至 5.2/100000 次分娩（<0.0001）。甲状旁腺功能亢进孕妇年龄较大，合并症较多，如肥胖、孕前高血压和糖尿病。与对照组相比，甲状旁腺功能亢进孕妇早产的可能性更大，比值比（OR）为 1.69（95%可信区间 1.24-2.29），发生子痫前期的可能性更大，OR 为 3.14（2.30-4.28），剖宫产的可能性更大，OR 为 1.69（1.36-2.09）。患有甲状旁腺功能亢进孕妇的婴儿更有可能出现生长受限，OR 为 1.83（1.08-3.07），并被诊断为先天性异常，OR 为 4.21（2.09-8.48）。
妊娠期间甲状旁腺功能亢进与不良围产期结局显著相关，包括子痫前期、早产、胎儿生长受限和先天性异常。因此，应将甲状旁腺功能亢进孕妇的妊娠视为高危妊娠，并建议提供专门护理，以最大程度地减少母婴发病率。
