孕期和产后手部及腕部软组织疾病的发病率和危险因素

Incidence and Risk Factors for Soft Tissue Hand and Wrist Conditions in Pregnancy and Postpartum.

作者信息

Smith Gabriella B, Young Bill, Titan Ashley L, Kenney Deborah E, Ladd Amy L

机构信息

Stanford University School of Medicine, Department of Orthopaedic Surgery, Redwood City, CA.

Stanford University School of Medicine, Department of Plastic Surgery, Palo Alto, CA.

出版信息

J Hand Surg Glob Online. 2025 Jul 24;7(5):100778. doi: 10.1016/j.jhsg.2025.100778. eCollection 2025 Sep.

DOI:10.1016/j.jhsg.2025.100778

PMID:40746749

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12312026/

Abstract

PURPOSE

This study aimed to identify the incidence of and risk factors associated with soft tissue hand conditions in pregnancy and postpartum. We hypothesized that the incidence of de Quervain tenosynovitis (DQT) and possibly carpal tunnel syndrome (CTS) and trigger finger would be higher in pregnancy and postpartum and that gestational diabetes would be a risk factor for these conditions.

METHODS

Using the PearlDiver administrative claims database, we identified pregnant females undergoing vaginal or Cesarean delivery from 2011 to 2022. This cohort was propensity score matched based on age and Elixhauser comorbidity index to females who were not pregnant. We identified pregnant females with a diagnosis of gestational diabetes. Multivariate regression models were used to assess the risk of developing a hand condition within the first year postpartum, adjusting for age, geographical region, insurance plan, comorbidity index, and inflammatory arthritis or diabetes diagnosis. We applied these models to evaluate the risk of developing a hand condition in gestational diabetes patients.

RESULTS

We identified a cohort of 357,534 postpartum patients and 357,803 control patients. We observed a 1.5% incidence of hand conditions postpartum compared to 1.3% in the control population ( < .001). Pregnancy was associated with an increased risk of diagnosis with DQT (odds ratio [OR], 5.11; 95% confidence interval [CI], 4.47-5.85; < .001). Gestational diabetes was also associated with an increased risk of a hand condition diagnosis (OR, 1.34; 95% CI, 1.26-1.42; < .001), specifically increased odds of CTS (OR, 1.40; 95% CI, 1.29-1.51; < .001) and DQT (OR, 1.23; 95% CI, 1.12-1.34; < .001).

CONCLUSIONS

Pregnancy is a significant risk factor for hand conditions and was associated with increased odds of DQT. Gestational diabetes is a significant risk factor for CTS and DQT. Our findings can inform screening and patient education efforts for high-risk pregnant patients.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IIIb.

摘要

目的

本研究旨在确定妊娠和产后手部软组织疾病的发病率及相关风险因素。我们假设，妊娠和产后桡骨茎突狭窄性腱鞘炎（DQT）、可能还有腕管综合征（CTS）和扳机指的发病率会更高，且妊娠期糖尿病会是这些疾病的一个风险因素。

方法

利用PearlDiver行政索赔数据库，我们确定了2011年至2022年期间接受阴道分娩或剖宫产的怀孕女性。该队列根据年龄和埃利克斯豪泽合并症指数与未怀孕女性进行倾向评分匹配。我们确定了诊断为妊娠期糖尿病的怀孕女性。使用多变量回归模型评估产后第一年内发生手部疾病的风险，并对年龄、地理区域、保险计划、合并症指数以及炎症性关节炎或糖尿病诊断进行了调整。我们应用这些模型来评估妊娠期糖尿病患者发生手部疾病的风险。

结果

我们确定了357,534名产后患者和357,803名对照患者。我们观察到产后手部疾病的发病率为1.5%，而对照人群为1.3%（P<0.001）。妊娠与DQT诊断风险增加相关（比值比[OR]，5.11；95%置信区间[CI]，4.47 - 5.85；P<0.001）。妊娠期糖尿病也与手部疾病诊断风险增加相关（OR，1.34；95%CI，1.26 - 1.