Department of Medicine, McGill University, Montreal, Quebec, Canada; Institut National de santé publique du Québec, Montreal, Quebec, Canada.
Institut National de santé publique du Québec, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada.
J Pediatr. 2024 Oct;273:114149. doi: 10.1016/j.jpeds.2024.114149. Epub 2024 Jun 14.
To investigate the risk of adverse neonatal events after a pregnancy complicated by severe maternal morbidity.
We analyzed a population-based cohort of deliveries in Quebec, Canada, between 2006 and 2021. The main exposure measure was severe maternal morbidity, comprising life-threatening conditions such as severe hemorrhage, cardiac complications, and eclampsia. The outcome included adverse neonatal events such as very preterm birth (gestational age <32 weeks), bronchopulmonary dysplasia, hypoxic ischemic encephalopathy, and neonatal death. Using log-binomial regression models, we estimated adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the association between severe maternal morbidity and adverse neonatal events.
Among 1 199 112 deliveries, 29 992 (2.5%) were complicated by severe maternal morbidity and 83 367 (7.0%) had adverse neonatal events. Severe maternal morbidity was associated with 2.96 times the risk of adverse neonatal events compared with no morbidity (95% CI 2.90-3.03). Associations were greatest for mothers who required assisted ventilation (RR 5.86, 95% CI 5.34-6.44), experienced uterine rupture (RR 4.54, 95% CI 3.73-5.51), or had cardiac complications (RR 4.39, 95% CI 3.98-4.84). Severe maternal morbidity was associated with ≥3 times the risk of neonatal death and hypoxic-ischemic encephalopathy and ≥10 times the risk of very preterm birth and bronchopulmonary dysplasia.
Severe maternal morbidity is associated with an elevated risk of adverse neonatal events. Better prevention of severe maternal morbidity may help reduce burden of severe neonatal morbidity.
探讨妊娠合并严重产妇并发症后不良新生儿事件的风险。
我们分析了 2006 年至 2021 年期间加拿大魁北克的一项基于人群的分娩队列。主要暴露测量指标为严重产妇并发症，包括危及生命的情况，如严重出血、心脏并发症和子痫。结果包括不良新生儿事件，如极早产儿（胎龄 <32 周）、支气管肺发育不良、缺氧缺血性脑病和新生儿死亡。使用对数二项式回归模型，我们估计了严重产妇并发症与不良新生儿事件之间的关联的调整相对风险（RR）和 95%置信区间（CI）。
在 1199120 次分娩中，29992（2.5%）例合并严重产妇并发症，83367（7.0%）例发生不良新生儿事件。与无并发症相比，严重产妇并发症与不良新生儿事件的风险增加了 2.96 倍（95%CI 2.90-3.03）。对于需要辅助通气的母亲（RR 5.86，95%CI 5.34-6.44）、经历子宫破裂的母亲（RR 4.54，95%CI 3.73-5.51）或有心脏并发症的母亲（RR 4.39，95%CI 3.98-4.84），关联最大。严重产妇并发症与新生儿死亡和缺氧缺血性脑病的风险增加≥3 倍，与极早产儿和支气管肺发育不良的风险增加≥10 倍相关。
严重产妇并发症与不良新生儿事件的风险增加相关。更好地预防严重产妇并发症可能有助于降低严重新生儿发病率的负担。
