美国一个大型全国队列中围产期心肌病与情绪障碍之间的关联。
Association between peripartum cardiomyopathy and mood disorders in a large, national U.S. cohort.
作者信息
Neuburg Blake, Harris Melissa, Palatnik Anna, Harrison Rachel
机构信息
Department of Obstetrics and Gynecology, The Ohio State University, 395 W 12th Ave, Columbus, OH 43210.
Institute for Health and Equity, Division of Epidemiology and Social Sciences, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226.
出版信息
medRxiv. 2025 Jan 3:2025.01.02.25319920. doi: 10.1101/2025.01.02.25319920.
OBJECTIVE
To examine the association between mood disorders in pregnancy and postpartum and peripartum cardiomyopathy (PPCM).
METHODS
Retrospective cohort study utilizing the National Inpatient Sample from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality of pregnant and postpartum patients from 2017-2019. Patients were separated into two groups based on ICD-10 coding for presence or absence of mood disorder (depression, bipolar depression, anxiety, or other mood diagnosis). The primary outcome was diagnosis of PPCM. Secondary outcomes included a composite of adverse cardiac events and maternal death. Groups were compared via t-tests, chi-squared analysis, and logistic regression that included all variables that differed between groups with p<0.05.
RESULTS
Over 2.2 million subjects were analyzed and approximately 168,000 (7.4%) had an ICD-10 diagnosis of mood disorder. Those with mood disorders were more likely to be non-Hispanic white, obese, tobacco users, publicly insured, have comorbidities, and deliver at a large, private, non-profit hospital (all p<0.05). They were delivered at an earlier gestational age and were also more likely to undergo cesarean (37.0±4.6 vs 37.8±3.7 weeks and 35.8% vs 31.8%, respectively, p<0.001). The primary outcome of PPCM was identified more than twice as often in those with mood disorder (0.12% vs 0.05%, p<0.001). Composite cardiac events, consisting of incidence of acute myocardial infarction, cardiac arrest, cardioversion, cardiac failure, and pulmonary edema were more frequent among patients with mood disorders (0.36% vs 0.14%, p<0.001). After controlling for confounders, PPCM remained independently associated with diagnosis of mood disorders (aOR 1.36, 95%CI 1.03-1.80) as did the composite of adverse cardiac events (aOR 1.57, 95% CI 1.37-1.81).
CONCLUSION
Mood disorders in pregnancy and postpartum are associated with increased rates of PPCM and other cardiac events.
目的
探讨妊娠及产后情绪障碍与围产期心肌病（PPCM）之间的关联。
方法
采用回顾性队列研究，利用医疗保健成本和利用项目的国家住院样本，该样本来自医疗保健研究与质量局2017 - 2019年的孕妇及产后患者。根据国际疾病分类第十版（ICD - 10）编码，将患者分为有或无情绪障碍（抑郁症、双相抑郁症、焦虑症或其他情绪诊断）两组。主要结局是PPCM的诊断。次要结局包括不良心脏事件和孕产妇死亡的综合情况。通过t检验、卡方分析和逻辑回归对两组进行比较，逻辑回归纳入了两组之间p<0.05的所有差异变量。
结果
分析了超过220万受试者，约16.8万（7.4%）有ICD - 10诊断的情绪障碍。有情绪障碍的人更可能是非西班牙裔白人、肥胖、吸烟、有公共保险、有合并症，且在大型私立非营利医院分娩（所有p<0.05）。她们的孕周较早，剖宫产的可能性也更高（分别为37.0±4.6周对37.8±3.7周，35.8%对31.8%，p<0.001）。情绪障碍患者中PPCM的主要结局确诊率是无情绪障碍者的两倍多（0.12%对0.05%，p<0.001）。由急性心肌梗死、心脏骤停、心脏复律、心力衰竭和肺水肿发生率组成的综合心脏事件在情绪障碍患者中更常见（0.36%对0.14%，p<0.001）。在控制混杂因素后，PPCM仍与情绪障碍诊断独立相关（调整优势比[aOR] 1.36，95%置信区间[CI] 1.03 - 1.80），不良心脏事件综合情况也是如此（aOR 1.57，95% CI 1.37 - 1.81）。
结论
妊娠及产后情绪障碍与PPCM及其他心脏事件发生率增加有关。
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