H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America.
Department of Gynecology & Obstetrics, Emory University, Atlanta, Georgia, United States of America.
PLoS One. 2024 Aug 12;19(8):e0306206. doi: 10.1371/journal.pone.0306206. eCollection 2024.
To determine how pre-existing conditions contribute to racial disparities in adverse maternal outcomes and incorporate these conditions into models to improve risk prediction for racial minority subgroups.
We used data from the "Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b)" observational cohort study. We defined multimorbidity as the co-occurrence of two or more pre-pregnancy conditions. The primary outcomes of interest were severe preeclampsia, postpartum readmission, and blood transfusion during pregnancy or up to 14 days postpartum. We used weighted Poisson regression with robust variance to estimate adjusted risk ratios and 95% confidence intervals, and we used mediation analysis to evaluate the contribution of the combined effects of pre-pregnancy conditions to racial/ethnic disparities. We also evaluated the predictive performance of our regression models by racial subgroup using the area under the receiver operating characteristic curve (AUC) metric.
In the nuMoM2b cohort (n = 8729), accounting for pre-existing conditions attenuated the association between non-Hispanic Black race/ethnicity and risk of severe preeclampsia. Cardiovascular and kidney conditions were associated with risk for severe preeclampsia among all women (aRR, 1.77; CI, 1.61-1.96, and aRR, 1.27; CI, 1.03-1.56 respectively). The mediation analysis results were not statistically significant; however, cardiovascular conditions explained 36.6% of the association between non-Hispanic Black race/ethnicity and severe preeclampsia (p = 0.07). The addition of pre-pregnancy conditions increased model performance for the prediction of severe preeclampsia.
Pre-existing conditions may explain some of the association between non-Hispanic Black race/ethnicity and severe preeclampsia. Specific pre-pregnancy conditions were associated with adverse maternal outcomes and the incorporation of comorbidities improved the performance of most risk prediction models.
确定既往疾病如何导致不良母婴结局的种族差异，并将这些疾病纳入模型，以提高对少数族裔亚组的风险预测。
我们使用了“初产妇母婴结局监测研究：监测孕妇（nuMoM2b）”观察性队列研究的数据。我们将多种合并症定义为两种或多种孕前疾病同时存在。主要感兴趣的结局是严重子痫前期、产后再入院、以及妊娠或产后 14 天内输血。我们使用加权泊松回归和稳健方差来估计调整后的风险比和 95%置信区间，并使用中介分析来评估孕前疾病对种族/族裔差异的综合影响。我们还通过种族亚组的接受者操作特征曲线（AUC）度量来评估我们回归模型的预测性能。
在 nuMoM2b 队列（n=8729）中，考虑到既往疾病会减弱非西班牙裔黑人种族与严重子痫前期风险之间的关联。心血管和肾脏疾病与所有女性的严重子痫前期风险相关（调整后的风险比，1.77；置信区间，1.61-1.96，和调整后的风险比，1.27；置信区间，1.03-1.56）。中介分析结果无统计学意义；然而，心血管疾病解释了非西班牙裔黑人种族与严重子痫前期之间关联的 36.6%（p=0.07）。孕前疾病的加入增加了严重子痫前期预测模型的性能。
既往疾病可能解释了非西班牙裔黑人种族与严重子痫前期之间的部分关联。特定的孕前疾病与不良母婴结局相关，合并症的纳入提高了大多数风险预测模型的性能。
