Fabricant Sonya P, Opara Karen N, Rau Alesandra R, Paul Julianna V, Girma Alodia, White Jessica D, Blissett Gabriella, Sriprasert Intira, Korst Lisa M, Chadwick Nicole M
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Department of Obstetrics & Gynecology, The University of Texas Health Science Center, Houston, TX 77030, USA.
J Clin Med. 2025 Aug 18;14(16):5823. doi: 10.3390/jcm14165823.
: Prior studies using administrative data have found that antenatal anemia is a risk factor for severe maternal morbidity (SMM). However, administrative definitions, including the commonly used definition from the Centers for Disease Control and Prevention (CDC), have a poor positive predictive value for some SMM components. We tested the relationship between hemoglobin level at delivery admission and SMM, as defined by gold-standard chart review. : This was a retrospective case-control study of deliveries at a high-acuity hospital in Los Angeles, California, from 2016 to 2019. Administrative data were screened to identify patients with CDC SMM. Control-patients were selected at random from screen-negative individuals. Medical records for all individuals were reviewed for gold-standard SMM criteria, and clinical data were abstracted. Confirmed-positive and confirmed-negative patients were compared using bivariate analyses. Multiple logistic regression models were developed to test the relationship between admission hemoglobin level and gold-standard SMM. : Of 4202 eligible individuals, 275 (6.5%) screened positive for SMM. Of these, 107 (38.5%) met gold-standard SMM criteria; 285 confirmed-negative controls were retained for analysis. Case-patients were more likely than control-patients to have anemia on delivery admission (43.9% vs. 24.2%, < 0.01) and had lower admission hemoglobin levels (11.2 ± 1.7 g/dL vs. 11.9 ± 1.3 g/dL, < 0.01). After controlling for covariates, admission hemoglobin was independently and inversely associated with gold-standard SMM (aOR = 0.76, 95% CI 0.60-0.96, = 0.02). : Lower hemoglobin level at delivery admission was associated with an increased risk of developing gold-standard SMM.
先前使用行政数据的研究发现，产前贫血是严重孕产妇发病（SMM）的一个风险因素。然而，包括疾病控制与预防中心（CDC）常用定义在内的行政定义，对某些SMM组成部分的阳性预测价值较低。我们测试了分娩入院时血红蛋白水平与通过金标准图表审查定义的SMM之间的关系。
这是一项对2016年至2019年加利福尼亚州洛杉矶一家高急症医院分娩情况的回顾性病例对照研究。对行政数据进行筛选以识别患有CDC定义的SMM的患者。对照患者从筛查阴性的个体中随机选择。对所有个体的病历进行审查以确定金标准SMM标准，并提取临床数据。使用双变量分析比较确诊阳性和确诊阴性患者。建立多元逻辑回归模型以测试入院血红蛋白水平与金标准SMM之间的关系。
在4202名符合条件的个体中，275名（6.5%）SMM筛查呈阳性。其中，107名（38.5%）符合金标准SMM标准；保留285名确诊阴性对照进行分析。病例患者在分娩入院时比对照患者更易患贫血（43.9%对24.2%，<0.01），且入院血红蛋白水平更低（11.2±1.7g/dL对11.9±1.3g/dL，<0.01）。在控制协变量后，入院血红蛋白与金标准SMM独立且呈负相关（调整后比值比 = 0.76，95%置信区间0.60 - 0.96，P = 0.02）。
分娩入院时较低的血红蛋白水平与发生金标准SMM的风险增加相关。
