Cozzi Gabriella D, Battarbee Ashley N, Sanjanwala Aalok R, Casey Brian M, Subramaniam Akila
Division of Maternal Fetal Medicine Center for Women's Reproductive Health, University of Alabama at Birmingham, Alabama.
Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama.
Am J Perinatol. 2024 May;41(S 01):e1521-e1530. doi: 10.1055/s-0043-1768232. Epub 2023 Apr 18.
This study aimed to estimate the association between number of maternal comorbidities and duration of expectant management and perinatal outcomes in patients with preeclampsia with severe features.
Retrospective cohort of patients with preeclampsia with severe features delivering live, nonanomalous singletons at 23 to 34 weeks' gestation at a single center from 2016 to 2018. Patients delivered for an indication other than severe preeclampsia were excluded. Patients were categorized based on the number (0, 1, or ≥2) of comorbidities present: chronic hypertension, pregestational diabetes, chronic kidney disease, and systemic lupus erythematosus. The primary outcome was proportion of potential expectant management time achieved, that is, days of expectant management achieved divided by total potential expectant management time (days from severe preeclampsia diagnosis to 34 weeks). Secondary outcomes included delivery gestational age, days of expectant management, and perinatal outcomes. Outcomes were compared in bivariable and multivariable analyses.
Of 337 patients included, 167 (50%) had 0, 151 (45%) had 1, and 19 (5%) had ≥2 comorbidities. Groups differed with respect to age, body mass index, race/ethnicity, insurance, and parity. The median proportion of potential expectant management achieved in this cohort was 1.8% (interquartile range: 0-15.4), and did not differ by number of comorbidities (adjusted : 5.3 [95% confidence interval [CI]: -2.1 to 12.9] for 1 comorbidity vs. 0 and adjusted : -2.9 [95% CI: -18.0 to 12.2] for ≥2 comorbidities vs. 0). There was no difference in delivery gestational age or duration of expectant management in days. Patients with ≥2 (vs. 0) comorbidities had higher odds of composite maternal morbidity (adjusted odds ratio: 3.0 [95% CI: 1.1-8.2]). There was no association between number of comorbidities and composite neonatal morbidity.
Among patients with preeclampsia with severe features, the number of comorbidities was not associated with duration of expectant management; however, patients with ≥2 comorbidities had higher odds of adverse maternal outcomes.
· Greater number of medical comorbidities were not associated with expectant management duration.. · Two or more medical comorbidities were associated with higher odds of adverse maternal outcomes.. · Expectant management should be undertaken cautiously in medically complicated patients..
本研究旨在评估重度子痫前期患者的孕产妇合并症数量与期待治疗时间及围产期结局之间的关联。
对2016年至2018年在单一中心孕23至34周分娩活产、非畸形单胎的重度子痫前期患者进行回顾性队列研究。排除因重度子痫前期以外的指征而分娩的患者。根据存在的合并症数量（0、1或≥2种）对患者进行分类：慢性高血压、孕前糖尿病、慢性肾病和系统性红斑狼疮。主要结局是实现的潜在期待治疗时间比例，即实现的期待治疗天数除以总潜在期待治疗时间（从重度子痫前期诊断至34周的天数）。次要结局包括分娩孕周、期待治疗天数和围产期结局。在双变量和多变量分析中对结局进行比较。
纳入的337例患者中，167例（50%）无合并症，151例（45%）有1种合并症，19例（5%）有≥2种合并症。各组在年龄、体重指数、种族/民族、保险和产次方面存在差异。该队列中实现的潜在期待治疗的中位数比例为1.8%（四分位间距：0 - 15.4），且不因合并症数量而异（1种合并症与无合并症相比，调整后比值比：5.3 [95%置信区间[CI]：-2.1至12.9]；≥2种合并症与无合并症相比，调整后比值比：-2.9 [95% CI：-18.0至12.2]）。分娩孕周或期待治疗天数无差异。有≥2种（与无合并症相比）合并症的患者发生孕产妇复合发病的几率更高（调整后比值比：3.0 [95% CI：1.1 - 8.2]）。合并症数量与新生儿复合发病之间无关联。
在重度子痫前期患者中，合并症数量与期待治疗时间无关；然而，有≥2种合并症的患者发生不良孕产妇结局的几率更高。
· 更多的内科合并症与期待治疗时间无关。· 两种或更多内科合并症与不良孕产妇结局的更高几率相关。· 对于有内科并发症的患者，应谨慎进行期待治疗。
