Trends and Outcomes among Pregnancy and Nonpregnancy-Related Hospitalizations with Diabetic Ketoacidosis.

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY American journal of perinatology Pub Date : 2025-01-01 Epub Date: 2024-05-28 DOI:10.1055/a-2334-8692

Ghamar Bitar, Baha M Sibai, Han-Yang Chen, Sarah A Nazeer, Suneet P Chauhan, Sean Blackwell, Michal Fishel Bartal

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Abstract

Objective: The study's primary objective was to evaluate adverse outcomes among reproductive-age hospitalizations with diabetic ketoacidosis (DKA), comparing those that are pregnancy-related versus nonpregnancy-related and evaluating temporal trends.

Study design: We conducted a retrospective cross-sectional study using the National Inpatient Sample to identify hospitalizations with DKA among reproductive-age women (15-49 years) in the United States (2016-2020). DKA in pregnancy hospitalizations was compared with DKA in nonpregnant hospitalizations. Adverse outcomes evaluated included mechanical ventilation, coma, seizures, renal failure, prolonged hospital stay, and in-hospital death. Multivariable Poisson regression models with robust error variance were used to estimate adjusted relative risk (aRR) and 95% confidence interval (CI). Annual percent change (APC) was used to calculate the change in DKA rate over time.

Results: Among 35,210,711 hospitalizations of reproductive-age women, 447,600 (1.2%) were hospitalized with DKA, and among them, 13,390 (3%) hospitalizations were pregnancy-related. The rate of nonpregnancy-related DKA hospitalizations increased over time (APC = 3.8%, 95% CI = 1.5-6.1). After multivariable adjustment, compared with pregnancy-related hospitalizations with DKA, the rates of mechanical ventilation (aRR = 1.56, 95% CI = 1.18-2.06), seizures (aRR = 2.26, 95% CI = 1.72-2.97), renal failure (aRR = 2.26, 95% CI = 2.05-2.50), coma (aRR = 2.53, 95% CI = 1.68-3.83), and in-hospital death (aRR = 2.38, 95% CI = 1.06-5.36) were higher among nonpregnancy-related hospitalizations with DKA.

Conclusion: A nationally representative sample of hospitalizations indicates that over the 5-year period, the rate of nonpregnancy-related DKA hospitalizations increased among reproductive age women, and a higher risk of adverse outcomes was observed when compared with pregnancy-related DKA hospitalizations.

Key points: · Over 5 years, the rate of pregnancy-related DKA hospitalizations was stable.. · Over 5 years, the rate of nonpregnancy-related DKA hospitalizations increased.. · There is a higher risk of adverse outcomes with DKA outside of pregnancy..

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妊娠期和非妊娠期糖尿病酮症酸中毒住院患者的趋势和治疗结果。

研究目的主要目的是评估育龄期糖尿病酮症酸中毒（DKA）住院患者的不良后果，比较与妊娠有关和无关的不良后果，并评估时间趋势：我们利用全国住院病人样本进行了一项回顾性横断面研究，以确定美国育龄妇女（15-49 岁）中因 DKA 住院的情况（2016-2020 年）。妊娠期 DKA 住院病例与非妊娠期 DKA 住院病例进行了比较。评估的不良后果包括机械通气、昏迷、癫痫发作、肾功能衰竭、住院时间延长和院内死亡。采用具有稳健误差方差的多变量泊松回归模型来估算调整后相对风险（aRR）和 95% 置信区间（CI）。年百分比变化（APC）用于计算DKA率随时间的变化：在 35 210 711 名住院的育龄妇女中，有 447 600 人（1.2%）因 DKA 住院，其中有 13 390 人（3%）与妊娠有关。非妊娠相关的 DKA 住院率随着时间的推移而增加（APC=3.8%，95% CI 1.5 - 6.1）。97）、肾功能衰竭（aRR=2.26，95% CI=2.05-2.50）、昏迷（aRR=2.53，95% CI=1.68-3.83）和院内死亡（aRR=2.38，95% CI=1.06-5.36）在非妊娠相关的DKA住院患者中更高：具有全国代表性的住院样本表明，5 年间，育龄妇女中与非妊娠相关的 DKA 住院率有所上升，与妊娠相关的 DKA 住院率相比，出现不良后果的风险更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of perinatology 医学-妇产科学

CiteScore

5.90

自引率

0.00%

发文量

302

审稿时长

4-8 weeks

期刊介绍： The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.