Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA.
Division of Rheumatology, University of California Los Angeles, Los Angeles, CA, USA.
Semin Arthritis Rheum. 2023 Dec;63:152252. doi: 10.1016/j.semarthrit.2023.152252. Epub 2023 Aug 22.
We sought to examine temporal trends in adverse pregnancy outcomes among SSc pregnancies in a large nationwide sample.
We used the National Inpatient Sample (NIS) database from 2000 - 2017 to derive national estimates of delivery-associated hospitalizations in the United States among patients with SSc. Each SSc delivery was matched to 100 non-SSc deliveries by age, delivery year, and race. We evaluated adverse pregnancy outcomes (APOs) including maternal and fetal death, cesarean delivery, hospital length of stay, preterm delivery, intrauterine growth restriction, and hypertensive disorders of pregnancy. We used multivariable regression models with an interaction term between SSc and year and adjusting for race, advanced maternal age, diabetes mellitus, and pre-existing hypertension to evaluate temporal trends in APOs among SSc and non-SSc deliveries.
From 2000 to 2017, there were 3740 delivery-associated hospitalizations for women with SSc. SSc was associated with an increased risk of all APOs compared to non-SSc deliveries. Fetal death declined in SSc deliveries from 49.0 per 1000 delivery-related admissions in 2000 - 2005 to 16.2 per 1000 in 2012 - 2017. There was a significant difference in trends for fetal death between SSc and non-SSc deliveries (p = 0.043), but the trends for other APOs did not differ between the two groups.
In this large nationwide sample, the risk of fetal death among women with SSc markedly improved over the past 18 years. The risk for other APOs remained high in SSc deliveries compared to non-SSc deliveries, and further studies are needed to determine what strategies can improve these outcomes.
我们旨在通过一个大型全国性样本，研究硬皮病妊娠不良妊娠结局的时间趋势。
我们使用 2000 年至 2017 年的国家住院患者样本（NIS）数据库，在美国患者中获得硬皮病相关分娩住院的全国估计值。每位硬皮病分娩患者都与 100 名非硬皮病分娩患者进行年龄、分娩年份和种族匹配。我们评估了不良妊娠结局（APO），包括孕产妇和胎儿死亡、剖宫产、住院时间、早产、宫内生长受限和妊娠高血压疾病。我们使用多变量回归模型，在 SSc 和年份之间使用交互项，并调整种族、高龄产妇、糖尿病和既往高血压，以评估 SSc 和非 SSc 分娩中 APO 的时间趋势。
2000 年至 2017 年，有 3740 例与分娩相关的住院治疗与患有硬皮病的女性有关。与非硬皮病分娩相比，硬皮病与所有 APO 的风险增加有关。2000 年至 2005 年，硬皮病分娩中胎儿死亡的比例为每 1000 例分娩相关住院患者 49.0 例，而 2012 年至 2017 年下降至每 1000 例 16.2 例。硬皮病和非硬皮病分娩之间的胎儿死亡趋势存在显著差异（p=0.043），但两组之间其他 APO 的趋势没有差异。
在这个大型全国性样本中，过去 18 年中，硬皮病女性的胎儿死亡风险显著降低。与非硬皮病分娩相比，硬皮病分娩的其他 APO 风险仍然很高，需要进一步研究以确定哪些策略可以改善这些结局。
