Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.
Fertil Steril. 2024 Aug;122(2):233-242. doi: 10.1016/j.fertnstert.2024.03.019. Epub 2024 Mar 24.
To assess national-level trends, characteristics, and outcomes of pregnancies with Turner syndrome in the United States.
Cross-sectional study.
The Healthcare Cost and Utilization Project's National Inpatient Sample.
A total of 17,865,495 hospital deliveries from 2016-2020.
A diagnosis of Turner syndrome, identified according to the World Health Organization's International Classification of Disease 10th revision code of Q96.
Obstetrics outcomes related to Turner syndrome, assessed with inverse probability of treatment weighting cohort and multivariable binary logistic regression modeling.
The prevalence of pregnant patients with Turner syndrome was 7.0 per 100,000 deliveries (one in 14,235). The number of hospital deliveries with patients who have a diagnosis of Turner syndrome increased from 5.0 to 11.7 per 100,000 deliveries during the study period (adjusted-odds ratio [aOR] for 2020 vs. 2016; 2.18, 95% confidence interval [CI] 1.83-2.60). Pregnant patients with Turner syndrome were more likely to have a diagnosis of pregestational hypertension (4.8% vs. 2.8%; aOR 1.65; 95% CI 1.26-2.15), uterine anomaly (1.6% vs. 0.4%; aOR, 3.01; 95% CI 1.93-4.69), and prior pregnancy losses (1.6% vs. 0.3%; aOR 4.70; 95% CI 3.01-7.32) compared with those without Turner syndrome. For the index obstetric characteristics, Turner syndrome was associated with an increased risk of intrauterine fetal demise (10.9% vs. 0.7%; aOR 8.40; 95% CI 5.30-13.30), intrauterine growth restriction (8.5% vs. 3.5%; aOR 2.11; 95% CI 1.48-2.99), and placenta accreta spectrum (aOR 3.63; 95% CI 1.20-10.97). For delivery outcome, pregnant patients with Turner syndrome were more likely to undergo cesarean delivery (41.6% vs. 32.3%; aOR 1.53; 95% CI 1.26-1.87). Moreover, the odds of periviable delivery (22-25 weeks: 6.1% vs. 0.4%; aOR 5.88; 95% CI 3.47-9.98) and previable delivery (<22 weeks: 3.3% vs. 0.3%; aOR 2.87; 95% CI 1.45-5.69) were increased compared with those without Turner syndrome.
The results of contemporaneous, nationwide assessment in the United States suggest that although pregnancy with Turner syndrome is uncommon this may represent a high-risk group, particularly for intrauterine fetal demise and periviable delivery. Establishing a society-based approach for preconception counseling and antenatal follow-up would be clinically compelling.
评估美国特纳综合征妊娠的国家水平趋势、特征和结局。
横断面研究。
医疗保健成本和利用项目的国家住院患者样本。
2016 年至 2020 年期间的 17865495 例医院分娩。
根据世界卫生组织国际疾病分类第 10 版代码 Q96 诊断特纳综合征。
特纳综合征相关产科结局，采用逆概率治疗加权队列和多变量二项逻辑回归模型评估。
特纳综合征孕妇的患病率为每 100000 例分娩中有 7.0 例（1/14235）。在研究期间，患有特纳综合征诊断的医院分娩数量从每 100000 例分娩中的 5.0 例增加到 11.7 例（2020 年与 2016 年相比，调整后的优势比[aOR]；2.18，95%置信区间[CI]1.83-2.60）。特纳综合征孕妇更有可能被诊断为先兆性高血压（4.8% vs. 2.8%；aOR 1.65；95% CI 1.26-2.15）、子宫异常（1.6% vs. 0.4%；aOR 3.01；95% CI 1.93-4.69）和先前妊娠丢失（1.6% vs. 0.3%；aOR 4.70；95% CI 3.01-7.32），与没有特纳综合征的孕妇相比。对于指数产科特征，特纳综合征与宫内胎儿死亡（10.9% vs. 0.7%；aOR 8.40；95% CI 5.30-13.30）、宫内生长受限（8.5% vs. 3.5%；aOR 2.11；95% CI 1.48-2.99）和胎盘附着异常谱（aOR 3.63；95% CI 1.20-10.97）的风险增加相关。在分娩结局方面，特纳综合征孕妇更有可能进行剖宫产（41.6% vs. 32.3%；aOR 1.53；95% CI 1.26-1.87）。此外，极早产儿分娩（22-25 周：6.1% vs. 0.4%；aOR 5.88；95% CI 3.47-9.98）和早产分娩（<22 周：3.3% vs. 0.3%；aOR 2.87；95% CI 1.45-5.69）的可能性均高于无特纳综合征孕妇。
美国同期全国评估结果表明，尽管特纳综合征妊娠不常见，但这可能代表一个高危群体，特别是与宫内胎儿死亡和极早产儿分娩相关。建立基于社会的孕前咨询和产前随访方法将具有临床吸引力。
