Nyarko Samuel H, Greenberg Lucy T, Phibbs Ciaran S, Buzas Jeffrey S, Lorch Scott A, Rogowski Jeannette, Saade George R, Passarella Molly, Boghossian Nansi S
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC.
Vermont Oxford Network, Burlington, VT.
Am J Obstet Gynecol. 2024 Mar;230(3):364.e1-364.e14. doi: 10.1016/j.ajog.2023.08.029. Epub 2023 Sep 1.
Severe maternal morbidity has been increasing in the past few decades. Few studies have examined the risk of severe maternal morbidity among individuals with stillbirths vs individuals with live-birth deliveries.
This study aimed to examine the prevalence and risk of severe maternal morbidity among individuals with stillbirths vs individuals with live-birth deliveries during delivery hospitalization as a primary outcome and during the postpartum period as a secondary outcome.
This was a retrospective cohort study using birth and fetal death certificate data linked to hospital discharge records from California (2008-2018), Michigan (2008-2020), Missouri (2008-2014), Pennsylvania (2008-2014), and South Carolina (2008-2020). Relative risk regression analysis was used to examine the crude and adjusted relative risks of severe maternal morbidity along with 95% confidence intervals among individuals with stillbirths vs individuals with live-birth deliveries, adjusting for birth year, state of residence, maternal sociodemographic characteristics, and the obstetric comorbidity index.
Of the 8,694,912 deliveries, 35,012 (0.40%) were stillbirths. Compared with individuals with live-birth deliveries, those with stillbirths were more likely to be non-Hispanic Black (10.8% vs 20.5%); have Medicaid (46.5% vs 52.0%); have pregnancy complications, including preexisting diabetes mellitus (1.1% vs 4.3%), preexisting hypertension (2.3% vs 6.2%), and preeclampsia (4.4% vs 8.4%); have multiple pregnancies (1.6% vs 6.2%); and reside in South Carolina (7.4% vs 11.6%). During delivery hospitalization, the prevalence rates of severe maternal morbidity were 791 cases per 10,000 deliveries for stillbirths and 154 cases per 10,000 deliveries for live-birth deliveries, whereas the prevalence rates for nontransfusion severe maternal morbidity were 502 cases per 10,000 deliveries for stillbirths and 68 cases per 10,000 deliveries for live-birth deliveries. The crude relative risk for severe maternal morbidity was 5.1 (95% confidence interval, 4.9-5.3), whereas the adjusted relative risk was 1.6 (95% confidence interval, 1.5-1.8). For nontransfusion severe maternal morbidity among stillbirths vs live-birth deliveries, the crude relative risk was 7.4 (95% confidence interval, 7.0-7.7), whereas the adjusted relative risk was 2.0 (95% confidence interval, 1.8-2.3). This risk was not only elevated among individuals with stillbirth during the delivery hospitalization but also through 1 year after delivery (severe maternal morbidity adjusted relative risk, 1.3; 95% confidence interval, 1.1-1.4; nontransfusion severe maternal morbidity adjusted relative risk, 1.2; 95% confidence interval, 1.1-1.3).
Stillbirth was found to be an important contributor to severe maternal morbidity.
在过去几十年中，严重孕产妇发病率一直在上升。很少有研究调查死产个体与活产个体相比发生严重孕产妇发病的风险。
本研究旨在将分娩住院期间严重孕产妇发病的患病率和风险作为主要结局，将产后期间严重孕产妇发病的患病率和风险作为次要结局，比较死产个体与活产个体。
这是一项回顾性队列研究，使用了与加利福尼亚州（2008 - 2018年）、密歇根州（2008 - 2020年）、密苏里州（2008 - 2014年）、宾夕法尼亚州（2008 - 2014年）和南卡罗来纳州（2008 - 2020年）的医院出院记录相关联的出生和胎儿死亡证明数据。采用相对风险回归分析来检验死产个体与活产个体相比严重孕产妇发病的粗相对风险和调整后相对风险以及95%置信区间，并对出生年份、居住州、孕产妇社会人口学特征和产科合并症指数进行了调整。
在8,694,912例分娩中，有35,012例（0.40%）为死产。与活产个体相比，死产个体更可能是非西班牙裔黑人（10.8%对20.5%）；有医疗补助（46.5%对52.0%）；有妊娠并发症，包括既往糖尿病（1.1%对4.3%）、既往高血压（2.3%对6.2%）和先兆子痫（4.4%对8.4%）；有多胎妊娠（1.6%对6.2%）；居住在南卡罗来纳州（7.4%对11.6%）。在分娩住院期间，死产的严重孕产妇发病率为每10,000例分娩791例，活产的严重孕产妇发病率为每10,000例分娩154例，而无输血的严重孕产妇发病率在死产中为每10,000例分娩502例，在活产中为每10,000例分娩68例。严重孕产妇发病的粗相对风险为5.1（95%置信区间，4.9 - 5.3），而调整后相对风险为1.6（95%置信区间，1.5 - 1.8）。对于死产与活产相比的无输血严重孕产妇发病，粗相对风险为7.4（95%置信区间，7.0 - 7.7），而调整后相对风险为2.0（95%置信区间，1.8 - 2.3）。这种风险不仅在分娩住院期间死产个体中升高，而且在分娩后1年内也升高（严重孕产妇发病调整后相对风险，1.3；95%置信区间，1.1 - 1.4；无输血严重孕产妇发病调整后相对风险，1.2；95%置信区间，1.1 - 1.3）。
发现死产是严重孕产妇发病的一个重要因素。
