Lobitz Gabriella, Rosenfeld Emily B, Lee Rachel, Sagaram Deepika, Ananth Cande V
Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
EClinicalMedicine. 2024 Sep 26;76:102851. doi: 10.1016/j.eclinm.2024.102851. eCollection 2024 Oct.
Cardiovascular disease (CVD) is increasing in prevalence and affects up to 4% of pregnancies in otherwise healthy persons. The specific factors that drive the development of CVD in pregnant people are poorly characterised. This study aimed to determine whether the mode of delivery in singletons affects the risk of cardiovascular morbidity and mortality within one year in patients without prior CVD.
We designed a retrospective cohort study utilising the Nationwide Readmissions Database (NRD) to identify singleton delivery hospitalisations in the United States from Jan 1, 2010 to Nov 30, 2018. (ICD) versions 9 and 10 codes were used to identify patients with readmission for CVD within the calendar year of index delivery. Patients aged 15-54 who underwent a singleton vaginal or caesarean delivery were included. Patients with pre-existing CVD hospitalisations before or during delivery, ectopic pregnancies, or abortive outcomes were excluded. Participant data was retrieved from the NRD database. The primary outcome was hospital readmission, defined by ICD 9 and 10 codes for fatal or non-fatal CVD in the same calendar year as delivery. Cox proportional hazard regression models were used to adjust for confounders. These included maternal age, hospital bed size, hospital type, hospital teaching status, income quartile, insurance, and year of delivery. Additional sub-analyses were performed adjusting for hypertensive disorders of pregnancy and diabetes mellitus.
Of the 14,179,299 singleton deliveries, 32% ( = 4,553,492) underwent a caesarean. CVD readmissions occurred in 255.2 per 100,000 ( = 11,710) caesarean deliveries compared with 133.9 per 100,000 ( = 12,507) vaginal deliveries (rate difference [RD], 121.4, 95% confidence interval [CI], 114.8-127.9; hazard ratio [HR] adjusted for all confounders including hypertensive disorders of pregnancy and diabetes mellitus was 1.42, 95% CI 1.35-1.50). This association was highest in the first 0-29 days following delivery (HR 1.68, 95% CI 1.59-1.78). The risk of readmission for CVD persisted for one year.
These findings suggest that caesarean delivery of singletons is associated with a higher risk of cardiovascular morbidity in patients without pre-existing CVD. This risk was highest in the first month but remained elevated for one year after delivery. These findings add to the accumulating evidence that undergoing caesarean delivery may have long-standing health implications and support the extension of the post-partum surveillance period. Limitations of this study include the lack of adjustment for body mass index, race, and parity. We were also unable to determine the reason for the caesarean delivery.
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心血管疾病（CVD）的患病率正在上升，在其他方面健康的人群中，高达4%的妊娠会受到影响。导致孕妇发生心血管疾病的具体因素尚不明确。本研究旨在确定单胎分娩方式是否会影响既往无心血管疾病患者在一年内发生心血管疾病的发病率和死亡率。
我们设计了一项回顾性队列研究，利用全国再入院数据库（NRD）来识别2010年1月1日至2018年11月30日期间在美国进行单胎分娩的住院病例。使用国际疾病分类（ICD）第9版和第10版编码来识别在索引分娩日历年因心血管疾病再次入院的患者。纳入年龄在15 - 54岁之间、进行单胎阴道分娩或剖宫产的患者。排除在分娩前或分娩期间有既往心血管疾病住院史、异位妊娠或流产结局的患者。从NRD数据库中检索参与者数据。主要结局是住院再入院，由分娩同年用于致命或非致命心血管疾病的ICD第9版和第10版编码定义。使用Cox比例风险回归模型对混杂因素进行调整。这些因素包括产妇年龄、医院床位规模、医院类型、医院教学状况、收入四分位数、保险类型和分娩年份。另外进行了亚分析，对妊娠高血压疾病和糖尿病进行了调整。
在14179299例单胎分娩中，32%（n = 4553492）为剖宫产。每100000例剖宫产中有255.2例（n = 11710）因心血管疾病再次入院，而每100000例阴道分娩中有133.9例（n = 12507）（率差[RD]为121.4，95%置信区间[CI]为114.8 - 127.9；调整包括妊娠高血压疾病和糖尿病在内的所有混杂因素后的风险比[HR]为1.42，95%CI为1.35 - 1.50）。这种关联在分娩后的前0 - 29天最高（HR为1.68，95%CI为1.59 - 1.78）。心血管疾病再次入院的风险持续一年。
这些发现表明，单胎剖宫产与既往无心血管疾病患者发生心血管疾病的较高风险相关。这种风险在产后第一个月最高，但在分娩后一年内仍持续升高。这些发现进一步证明了剖宫产可能对健康有长期影响，并支持延长产后监测期。本研究的局限性包括未对体重指数、种族和产次进行调整。我们也无法确定剖宫产的原因。
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