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在具有高并发症负担的产科人群中出现重复重复的孕产妇发病率
Claire McIlwraith1, Ayodeji Sanusi, Gerald McGwin
1Department of Obstetrics and Gynecology, the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, the Center for Women's Reproductive Health, and the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
在之前的怀孕中经历过严重孕产妇死亡率 (SMM) 的妇女在随后的怀孕中面临极高的SMM风险. 这些风险在输血和非输血相关的SMM中显著增加,这强调了针对性干预的必要性.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇健康 孕产妇健康
- 公共卫生 公共卫生
背景情况:
- 严重的孕产妇发病率 (SMM) 是一个重大的公共卫生问题.
- 之前的SMM是已知的后续怀孕不良结果的风险因素.
- 量化这些风险对于制定有效的预防策略至关重要.
研究的目的:
- 评估SMM病史患者与没有SMM病史患者的后期怀孕中严重孕产妇发病率 (SMM) 的风险.
- 具体评估随后怀孕中输血相关的SMM和非输血相关的SMM的风险.
- 检查在经历了以前的SMM事件后,发展出不同类型的SMM的风险.
主要方法:
- 追溯队列研究包括852名患者,在2015-2018年间至少有两次分娩.
- 主要暴露:SMM (输血或非输血) 在第一个捕获的怀孕.
- 主要结局:SMM (输血或不输血) 在随后的怀孕中,使用概括估计方程模型进行分析.
主要成果:
- 在之前的怀孕中接受输血SMM的患者在随后的怀孕中发生输血SMM的风险增加了16倍 (57.8% vs 3.5%).
- 在之前的怀孕中患有非输血SMM的患者在随后的怀孕中患有非输血SMM的风险增加了23倍 (16.7%vs0.7%).
- 输血SMM的病史也增加了后期怀孕中非输血SMM的风险 (RR 6.2).
结论:
- 在先前的SMM事件之后的后续怀孕中,SMM的风险异常高,超过了先前的估计.
- 伴随性疾病和健康的社会决定因素,如社会脆弱性,需要进一步调查以告知干预措施.
- 需要有针对性的干预措施来缓解后续怀孕中SMM的高风险.
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