Fang Zhuanji, Zhang Huale, Xu Guizhen, Zhang Qinjian, Huang Liping, Yan Jianying
Zhuanji Fang Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Fuzhou, Fujian Province 350001, P.R. China.
Huale Zhang Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18 Daoshan Road, Fuzhou, Fujian Province 350001, P.R. China.
Pak J Med Sci. 2025 Jul;41(7):1872-1880. doi: 10.12669/pjms.41.7.12023.
To identify significant risk factors associated with severe maternal morbidity(SMM) in patients with hypertensive disorder of pregnancy (HDP).
This retrospective study analyzed clinical data from patients with HDP who delivered at Fujian Maternity and Children Health Hospital between January 2013 and March 2022. Univariate logistic regression analysis was performed to identify risk factors for developing SMM. Significant risk factors (P < 0.05) were considered for inclusion in multivariate logistic regression using stepwise regression with forward and backward selection.
Of 3133 HDP patients included in the study, 365 met the diagnostic criteria of SMM and were included in the SMM group, while 2768 patients comprised the control group. The SMM group had a significantly higher incidence of gestational hypertension diagnosed at ≤ 34 weeks of gestation compared to the control group (30.14% vs. 12.64%, p<0.0001). Patients in the SMM group had a higher incidence of previous history of preeclampsia compared to the control group (1.64% vs. 0.25%, p=0.0001). Logistic regression analysis identified parity (OR, 1.37; CI, 1.05-1.78; p=0.0205), gestational age of diagnosis (OR, 2.22; CI, 1.68-2.92; p<0.0001), iron supplementation (OR, 2.31; CI, 1.83-2.93; p<0.0001), and preeclampsia (OR, 3.10; CI, 2.42-3.98; p<0.0001) as significant risk factors for SMM. Stepwise regression analysis confirmed that parity (OR, 1.43; CI, 1.17-1.73; p=0.0004), gestational age of diagnosis (OR, 2.32; CI, 1.77-3.05; p<0.0001), iron supplementation (OR, 2.30; CI, 1.82-2.90; p<0.0001), and preeclampsia (OR, 3.34; CI, 2.63-4.24; p<0.0001) remained significantly associated with SMM.
Gestational age of diagnosis, iron supplementation, and history of preeclampsia were identified as risk factors of SMM in patients with HDP. Our results can help identify high-risk patients for early recognition and management of SMM.
确定妊娠高血压疾病（HDP）患者中与严重孕产妇发病（SMM）相关的重要危险因素。
这项回顾性研究分析了2013年1月至2022年3月在福建省妇幼保健院分娩的HDP患者的临床资料。进行单因素逻辑回归分析以确定发生SMM的危险因素。使用逐步回归的向前和向后选择法，将显著危险因素（P<0.05）纳入多因素逻辑回归分析。
在纳入研究的3133例HDP患者中，365例符合SMM诊断标准并被纳入SMM组，而2768例患者组成对照组。与对照组相比，SMM组在妊娠≤34周时诊断为妊娠期高血压的发生率显著更高（30.14%对12.64%，p<0.0001）。与对照组相比，SMM组子痫前期既往史的发生率更高（1.64%对0.25%，p=0.0001）。逻辑回归分析确定产次（OR，1.37；CI，1.05-1.78；p=0.0205）、诊断时的孕周（OR，2.22；CI，1.68-2.92；p<0.0001）、铁剂补充（OR，2.31；CI，1.83-2.93；p<0.0001）和子痫前期（OR，3.10；CI，2.42-3.98；p<0.0001）为SMM的显著危险因素。逐步回归分析证实产次（OR，1.43；CI，1.17-1.73；p=0.0004）、诊断时的孕周（OR，2.32；CI，1.77-3.05；p<0.0001）、铁剂补充（OR，2.30；CI，1.82-2.90；p<0.0001）和子痫前期（OR，3.34；CI，2.63-4.24；p<0.0001）仍与SMM显著相关。
诊断时的孕周、铁剂补充和子痫前期既往史被确定为HDP患者发生SMM的危险因素。我们的结果有助于识别高危患者，以便对SMM进行早期识别和管理。
