Cohen Alexa, Lambert Calvin, Yanik Megan, Nathan Lisa, Rosenberg Henri M, Tavella Nicola, Bianco Angela, Futterman Itamar, Haberman Shoshana, Griffin Myah M, Limaye Meghana, Owens Thomas, Brustman Lois, Wu Haotian, Dar Pe'er, Jessel Rebecca H, Doulaveris Georgios
Division of Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (Cohen, Lambert, Yanik, Nathan, Dar, and Doulaveris).
Division of Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY (Cohen, Lambert, Yanik, Nathan, Dar, and Doulaveris); Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY (Lambert, Rosenberg, Tavella, and Bianco).
Am J Obstet Gynecol MFM. 2024 Jul;6(7):101386. doi: 10.1016/j.ajogmf.2024.101386. Epub 2024 May 17.
Placenta accreta spectrum is associated with significant maternal and neonatal morbidity and mortality. There is limited established data on healthcare inequities in the outcomes of patients with placenta accreta spectrum.
This study aimed to investigate health inequities in maternal and neonatal outcomes of pregnancies with placenta accreta spectrum.
This multicentered retrospective cohort study included patients with a histopathological diagnosis of placenta accreta spectrum at 4 regional perinatal centers between January 1, 2013, and June 30, 2022. Maternal race and ethnicity were categorized as either Hispanic, non-Hispanic Black, non-Hispanic White, or Asian or Pacific Islander. The primary outcome was a composite adverse maternal outcome: transfusion of ≥4 units of packed red blood cells, vasopressor use, mechanical ventilation, bowel or bladder injury, or mortality. The secondary outcomes were a composite adverse neonatal outcome (Apgar score of <7 at 1 minute, morbidity, or mortality), gestational age at placenta accreta spectrum diagnosis, and planned delivery by a multidisciplinary team. Multivariable logistic regression was used to estimate the associations of race and ethnicity with maternal and neonatal outcomes.
A total of 408 pregnancies with placenta accreta spectrum were included. In 218 patients (53.0%), the diagnosis of placenta accreta spectrum was made antenatally. Patients predominantly self-identified as non-Hispanic White (31.6%) or non-Hispanic Black (24.5%). After adjusting for institution, age, body mass index, income, and parity, there was no difference in composite adverse maternal outcomes among the racial and ethnic groups. Similarly, adverse neonatal outcomes, gestational age at prenatal diagnosis, rate of planned delivery by a multidisciplinary team, and cesarean hysterectomy were similar among groups.
In our multicentered placenta accreta spectrum cohort, race and ethnicity were not associated with inequities in composite maternal or neonatal morbidity, timing of diagnosis, or planned multidisciplinary care. This study hypothesized that a comparable incidence of individual risk factors for perinatal morbidity and geographic proximity reduces potential inequities that may exist in a larger population.
胎盘植入谱系疾病与孕产妇和新生儿的严重发病率和死亡率相关。关于胎盘植入谱系疾病患者治疗结果方面的医疗保健不平等的既定数据有限。
本研究旨在调查胎盘植入谱系疾病妊娠的孕产妇和新生儿结局中的健康不平等情况。
这项多中心回顾性队列研究纳入了2013年1月1日至2022年6月30日期间在4个地区围产期中心经组织病理学诊断为胎盘植入谱系疾病的患者。孕产妇的种族和族裔分为西班牙裔、非西班牙裔黑人、非西班牙裔白人或亚裔或太平洋岛民。主要结局是综合不良孕产妇结局：输注≥4单位浓缩红细胞、使用血管加压药、机械通气、肠道或膀胱损伤或死亡。次要结局是综合不良新生儿结局（1分钟时阿氏评分<7分、发病或死亡）、胎盘植入谱系疾病诊断时的孕周以及多学科团队计划分娩情况。采用多变量逻辑回归来估计种族和族裔与孕产妇和新生儿结局之间的关联。
共纳入408例胎盘植入谱系疾病妊娠。218例患者（53.0%）在产前被诊断为胎盘植入谱系疾病。患者主要自我认定为非西班牙裔白人（31.6%）或非西班牙裔黑人（24.5%）。在调整了机构、年龄、体重指数、收入和产次后，各种族和族裔群体之间的综合不良孕产妇结局没有差异。同样，各群体之间的不良新生儿结局、产前诊断时的孕周、多学科团队计划分娩率和剖宫产子宫切除术情况相似。
在我们的多中心胎盘植入谱系疾病队列中，种族和族裔与综合孕产妇或新生儿发病率、诊断时间或计划的多学科护理方面的不平等无关。本研究推测，围产期发病率的个体风险因素发生率相当以及地理位置相近减少了可能在更大人群中存在的潜在不平等。
