Declercq Eugene R, Cabral Howard J, Liu Chia-Ling, Amutah-Onukagha Ndidiamaka, Meadows Audra, Cui Xiaohui, Diop Hafsatou
Boston University School of Public Health, the Department of Public Health and Community Medicine, Tufts University School of Medicine, and the Massachusetts Department of Public Health, Boston, and Evalogic Services, Inc., Newton, Massachusetts; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, San Diego, California.
Obstet Gynecol. 2023 Dec 1;142(6):1423-1430. doi: 10.1097/AOG.0000000000005398. Epub 2023 Oct 5.
To examine demographic and clinical precursors to pregnancy-associated deaths overall and when pregnancy-related deaths are excluded.
We conducted a retrospective cohort study based on a Massachusetts population-based data system linking data from live birth and fetal death certificates to corresponding delivery hospital discharge records and a birthing individual's nonbirth hospital contacts and associated death records. Exposures included maternal demographics, severe maternal morbidity (without transfusion), hospitalizations in the 3 years before pregnancy, comorbidities during pregnancy, and opioid use. In cases of postpartum deaths, hospitalization between delivery and death was examined. The primary outcome measure was pregnancy-associated death , defined as death during pregnancy or up to 1 year postpartum.
There were 1,291,626 deliveries between 2002 and 2019, of which 384 were linked to pregnancy-associated deaths. Pregnancy-associated but not pregnancy-related deaths (per 100,000 deliveries) were highest for birthing people with opioid use before pregnancy (498.3), severe maternal morbidity (387.3), a comorbidity (106.3), or a prior hospitalization (88.9). In multivariable analysis, the adjusted risk ratios associated with severe maternal morbidity (9.37, 95% CI, 6.14-14.31) and opioid use (6.49, 95%, CI, 3.71-11.35) were highest. Individuals with pregnancy-associated deaths were also more likely to have been hospitalized before or during pregnancy (2.30, 95% CI, 1.62-3.26). Among postpartum deaths, more than two-thirds (69.9%) of birthing people had a hospital contact after delivery and before their death.
Severe maternal morbidity and opioid use disorder were precursors to pregnancy-associated deaths. Individuals with pregnancy-associated but not pregnancy-related deaths experienced a history of hospital contacts during and after pregnancy before death.
总体上以及排除与妊娠相关的死亡后，研究妊娠相关死亡的人口统计学和临床先兆因素。
我们基于马萨诸塞州的一个以人群为基础的数据系统进行了一项回顾性队列研究，该系统将活产和胎儿死亡证明数据与相应的分娩医院出院记录以及分娩个体的非分娩医院接触记录和相关死亡记录相链接。暴露因素包括孕产妇人口统计学特征、严重孕产妇发病率（无输血情况）、妊娠前3年的住院情况、妊娠期间的合并症以及阿片类药物使用情况。对于产后死亡病例，检查了分娩至死亡期间的住院情况。主要结局指标为妊娠相关死亡，定义为妊娠期间或产后1年内死亡。
2002年至2019年期间共有1,291,626例分娩，其中384例与妊娠相关死亡有关。妊娠前使用阿片类药物的分娩者（每10万例分娩中有498.3例）、严重孕产妇发病率（387.3例）、合并症（106.3例）或既往住院史（88.9例）的妊娠相关但非妊娠相关死亡（每10万例分娩）发生率最高。在多变量分析中，与严重孕产妇发病率（9.37，95%可信区间，6.14 - 14.31）和阿片类药物使用（6.49，95%，可信区间，3.71 - 11.35）相关的调整风险比最高。发生妊娠相关死亡的个体在妊娠前或妊娠期间住院的可能性也更高（2.30，95%可信区间，1.62 - 3.26）。在产后死亡病例中，超过三分之二（69.9%）的分娩者在分娩后至死亡前有过医院接触。
严重孕产妇发病率和阿片类药物使用障碍是妊娠相关死亡的先兆因素。发生妊娠相关但非妊娠相关死亡的个体在死亡前在妊娠期间及产后有过医院接触史。
