强直性脊柱炎女性患者的产科和新生儿结局——人群数据库评估。
Obstetric and neonatal outcomes in women with Ankylosing spondylitis - an evaluation of a population database.
机构信息
Department of Obstetrics and Gynecology, McGill University, 845 Rue Sherbrooke, O, Montreal, Montréal, Quebec, QC, 3HA 0G4, Canada.
The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
BMC Pregnancy Childbirth. 2024 Oct 3;24(1):639. doi: 10.1186/s12884-024-06833-0.
BACKGROUND
Ankylosing Spondylitis (AS) is a systemic chronic rheumatic disease characterized by involvement of the axial skeletal and sacroiliac joints. Although this disease is not rare amongst women of reproductive age, data regarding pregnancy outcomes have demonstrated conflicting results. We therefore aimed to compare pregnancy and perinatal outcomes between women who suffered from AS to those who did not.
METHODS
A retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Included in the study were all pregnant women who delivered or had a maternal death in the US between 2004 and 2014. Women with an ICD-9 diagnosis of AS before or during pregnancy were compared to those without. Pregnancy, delivery, and neonatal outcomes were compared between the two groups using multivariate logistic regression models adjusting for potential confounders.
RESULTS
A total of 9,096,788 women were inclusion in the analysis. Amongst them, 383 women (3.8/100,000) had a diagnosis of AS and the rest were controls. Women with AS, compared to those without, were more likely to be older; Caucasian; from higher income quartiles; suffer from thyroid disorders, and have multiple pregnancies (p < 0.001, all). After adjusting for confounders, patients in the AS group, compared to those without, had a higher rate of cesarean delivery (CD) (aOR 1.47, 95% CI 1.14-1.91, p = 0.003); gestational diabetes (aOR 1.55, 95% CI 1.02-2.33, p = 0.038); and placenta previa (aOR 3.6, 95% CI 1.6-8.12, p = 0.002). Regarding neonatal outcomes, patients with AS, compared to those without, had a higher rate of small-for-gestational-age (SGA) neonates (aOR 2.19, 95% CI 1.22-3.93, p = 0.009); and intrauterine fetal death (IUFD) (aOR 3.46, 95% CI 1.11-10.83, p = 0.033).
CONCLUSION
Women diagnosed with AS have an increased risk of obstetric complications, including CD, as well as an increased risk of SGA and IUFD.
背景
强直性脊柱炎（AS）是一种系统性慢性风湿性疾病，其特征为中轴骨骼和骶髂关节受累。尽管这种疾病在育龄妇女中并不罕见，但有关妊娠结局的数据却显示出相互矛盾的结果。因此，我们旨在比较患有 AS 的女性和未患有 AS 的女性的妊娠和围产期结局。
方法
这是一项使用医疗保健成本和利用项目、全国住院患者样本（HCUP-NIS）的回顾性队列研究。研究纳入了 2004 年至 2014 年期间在美国分娩或产妇死亡的所有孕妇。将在妊娠前或妊娠期间患有 AS 的 ICD-9 诊断的女性与没有 AS 的女性进行比较。使用多变量逻辑回归模型比较两组之间的妊娠、分娩和新生儿结局，并调整潜在混杂因素。
结果
共有 9096788 名女性纳入分析。其中，383 名女性（3.8/100,000）被诊断为 AS，其余为对照组。与没有 AS 的女性相比，患有 AS 的女性年龄更大；白人；收入处于较高四分位数；患有甲状腺疾病，并且有多胎妊娠（均 p<0.001）。调整混杂因素后，与没有 AS 的女性相比，AS 组患者的剖宫产率（CD）更高（aOR 1.47，95%CI 1.14-1.91，p=0.003）；妊娠期糖尿病（aOR 1.55，95%CI 1.02-2.33，p=0.038）；以及前置胎盘（aOR 3.6，95%CI 1.6-8.12，p=0.002）。关于新生儿结局，与没有 AS 的女性相比，患有 AS 的女性的小于胎龄儿（SGA）新生儿的发生率更高（aOR 2.19，95%CI 1.22-3.93，p=0.009）；以及宫内胎儿死亡（IUFD）（aOR 3.46，95%CI 1.11-10.83，p=0.033）。
结论
诊断为 AS 的女性发生产科并发症（包括 CD）的风险增加，SGA 和 IUFD 的风险也增加。
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