Virginia Watkins, Miriam Estin, Amanda Craig, Sarah Dotters-Katz, Jerome J Federspiel
{"title":"Hereditary Hemorrhagic Telangiectasia: pregnancy and delivery-specific considerations and outcomes.","authors":"Virginia Watkins, Miriam Estin, Amanda Craig, Sarah Dotters-Katz, Jerome J Federspiel","doi":"10.1055/a-2419-9036","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Prior studies have evaluated maternal outcomes in patients with hereditary hemorrhagic telangiectasia (HHT), yet pregnancy and delivery-specific data remain limited. This study aims to evaluate pregnancy and delivery outcomes in patients with HHT.</p><p><strong>Study design: </strong>This retrospective cohort study used the Nationwide Readmissions Database to identify patients with HHT diagnosis on delivery between 2010-2021. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included non-transfusion SMM, preterm birth, stillbirth, prelabor rupture of membranes (PROM) or preterm prelabor rupture of membranes (PPROM), cesarean delivery, respiratory bleeding, cerebrovascular complications, patient disposition, and length of stay. Trends in the prevalence of HHT at delivery were assessed with logistic regression. Logistic regression analyses, adjusting for age, payer, zip code income, hospital size and teaching status, were also used to produce adjusted relationships between HHT status and outcomes.</p><p><strong>Results: </strong>The cohort of 21,698,861 delivered pregnancies corresponded to a national estimate of 44,325,599. Of those, 612 (national estimate: 1,265; 2.8 per 100,000) had a diagnosis of HHT. A steady rise in HHT diagnosis rate during pregnancy from 2010 to 2021 (1.7 per 100,000 in 2010, 3.8 per 100,000 in 2021, p<0.001 for trend) was seen. Patients with HHT were significantly more likely to experience SMM compared to patients without HHT (7.8% vs 1.7%, adjusted relative risk (aRR) 4.49 [95% CI 3.06, 6.58]). Rates of preterm birth (14.2% vs 8.5%, aRR 1.57 [95% CI 1.22, 2.03]), cesarean delivery (41.0% vs 32.9%, aRR 1.23 [95% CI 1.07, 1.41]), respiratory bleeding (2.1% vs <0.1%, aRR 94.44 [56.64, 157.46]) and cerebrovascular complications (0.9% vs <0.1%, aRR 22.89 [9.89, 52.96]) were higher in patients with HHT than non-HHT patients. There was no difference in stillbirth rates between groups.</p><p><strong>Conclusion: </strong>Patients with HHT have higher rates of SMM and adverse delivery outcomes when compared to the baseline population.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of perinatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2419-9036","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Prior studies have evaluated maternal outcomes in patients with hereditary hemorrhagic telangiectasia (HHT), yet pregnancy and delivery-specific data remain limited. This study aims to evaluate pregnancy and delivery outcomes in patients with HHT.
Study design: This retrospective cohort study used the Nationwide Readmissions Database to identify patients with HHT diagnosis on delivery between 2010-2021. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included non-transfusion SMM, preterm birth, stillbirth, prelabor rupture of membranes (PROM) or preterm prelabor rupture of membranes (PPROM), cesarean delivery, respiratory bleeding, cerebrovascular complications, patient disposition, and length of stay. Trends in the prevalence of HHT at delivery were assessed with logistic regression. Logistic regression analyses, adjusting for age, payer, zip code income, hospital size and teaching status, were also used to produce adjusted relationships between HHT status and outcomes.
Results: The cohort of 21,698,861 delivered pregnancies corresponded to a national estimate of 44,325,599. Of those, 612 (national estimate: 1,265; 2.8 per 100,000) had a diagnosis of HHT. A steady rise in HHT diagnosis rate during pregnancy from 2010 to 2021 (1.7 per 100,000 in 2010, 3.8 per 100,000 in 2021, p<0.001 for trend) was seen. Patients with HHT were significantly more likely to experience SMM compared to patients without HHT (7.8% vs 1.7%, adjusted relative risk (aRR) 4.49 [95% CI 3.06, 6.58]). Rates of preterm birth (14.2% vs 8.5%, aRR 1.57 [95% CI 1.22, 2.03]), cesarean delivery (41.0% vs 32.9%, aRR 1.23 [95% CI 1.07, 1.41]), respiratory bleeding (2.1% vs <0.1%, aRR 94.44 [56.64, 157.46]) and cerebrovascular complications (0.9% vs <0.1%, aRR 22.89 [9.89, 52.96]) were higher in patients with HHT than non-HHT patients. There was no difference in stillbirth rates between groups.
Conclusion: Patients with HHT have higher rates of SMM and adverse delivery outcomes when compared to the baseline population.
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.