{"title":"胎儿异常对产妇的影响:基于人口的横断面研究。","authors":"","doi":"10.1016/j.ajogmf.2024.101440","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Although it is well-known that the presence of fetal anomalies is associated with maternal morbidity, granular information on these risks by type of anomaly is not available.</p></div><div><h3>Objective</h3><p>To examine adverse maternal outcomes according to the type of fetal anomaly.</p></div><div><h3>Study Design</h3><p>This was a repeated cross-sectional analysis of US vital statistics Live Birth/Infant Death linked data from 2011 to 2020. All pregnancies at 20 weeks or greater were included. Our primary outcome was severe maternal morbidity (SMM), defined as any maternal intensive care unit admission, transfusion, uterine rupture, or hysterectomy. Outcomes were compared between pregnancies with a specific type of fetal anomaly and pregnancies without any fetal anomaly. Fetal anomalies that were available in the dataset included anencephaly, meningomyelocele/spina bifida, cyanotic congenital heart disease, congenital diaphragmatic hernia, omphalocele, gastroschisis, cleft lip and/or palate, hypospadias, limb anomaly, and chromosomal disorders. If a fetus had more than one anomaly, it was classified as multiple anomalies. Adjusted relative risks (aRR) with 99% confidence intervals (99% CI) were calculated using modified Poisson regression. Adjusted risk differences (aRDs) were calculated using the marginal standardization form of predictive margins.</p></div><div><h3>Results</h3><p>Of 35,760,626 pregnancies included in the analysis, 35,655,624 pregnancies had no fetal anomaly and 105,002 had isolated or multiple fetal anomalies. Compared to pregnancies without fetal anomaly, all fetal anomalies were associated with an increased risk of SMM except for gastroschisis and limb anomaly in order of aRRs (99% CI): 1.58 (1.29–1.92) with cleft lip and/or palate; 1.75 (1.35–2.27) with multiple anomalies; 1.76 (1.18–2.63) with a chromosomal disorder; 2.19 (1.82–2.63) with hypospadias; 2.20 (1.51–3.21) with spina bifida; 2.39 (1.62–3.53) with congenital diaphragmatic hernia; 2.66 (2.27–3.13) with congenital heart disease; 3.15 (2.08–4.76) with omphalocele; and 3.27 (2.22–4.80) with anencephaly. Compared to pregnancies without fetal anomaly, all fetal anomalies were associated with an increased absolute risk of SMM except for gastroschisis and limb anomaly in order of aRDs (99% CI): 0.26 (0.12–0.40) with cleft lip and/or palate, 0.34 (0.13–0.55) with multiple anomalies, 0.34 (0.02–0.66) with a chromosomal disorder, 0.54 (0.36–0.72) with hypospadias, 0.54 (0.17–0.92) with spina bifida, 0.63 (0.21–1.05) with congenital diaphragmatic hernia, 0.75 (0.56–0.95) with congenital heart disease, 0.97 (0.38–1.56) with omphalocele, and 1.03 (0.46–1.59) with anencephaly.</p></div><div><h3>Conclusion</h3><p>The presence of fetal anomalies is associated with adverse maternal health outcomes. The risk of SMM varies according to the type of fetal anomaly. Counseling mothers about the maternal implications of fetal anomalies is paramount to help them make informed decisions regarding their pregnancy outcome.</p></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Maternal implications of fetal anomalies: a population-based cross-sectional study\",\"authors\":\"\",\"doi\":\"10.1016/j.ajogmf.2024.101440\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Although it is well-known that the presence of fetal anomalies is associated with maternal morbidity, granular information on these risks by type of anomaly is not available.</p></div><div><h3>Objective</h3><p>To examine adverse maternal outcomes according to the type of fetal anomaly.</p></div><div><h3>Study Design</h3><p>This was a repeated cross-sectional analysis of US vital statistics Live Birth/Infant Death linked data from 2011 to 2020. All pregnancies at 20 weeks or greater were included. Our primary outcome was severe maternal morbidity (SMM), defined as any maternal intensive care unit admission, transfusion, uterine rupture, or hysterectomy. Outcomes were compared between pregnancies with a specific type of fetal anomaly and pregnancies without any fetal anomaly. Fetal anomalies that were available in the dataset included anencephaly, meningomyelocele/spina bifida, cyanotic congenital heart disease, congenital diaphragmatic hernia, omphalocele, gastroschisis, cleft lip and/or palate, hypospadias, limb anomaly, and chromosomal disorders. If a fetus had more than one anomaly, it was classified as multiple anomalies. Adjusted relative risks (aRR) with 99% confidence intervals (99% CI) were calculated using modified Poisson regression. Adjusted risk differences (aRDs) were calculated using the marginal standardization form of predictive margins.</p></div><div><h3>Results</h3><p>Of 35,760,626 pregnancies included in the analysis, 35,655,624 pregnancies had no fetal anomaly and 105,002 had isolated or multiple fetal anomalies. Compared to pregnancies without fetal anomaly, all fetal anomalies were associated with an increased risk of SMM except for gastroschisis and limb anomaly in order of aRRs (99% CI): 1.58 (1.29–1.92) with cleft lip and/or palate; 1.75 (1.35–2.27) with multiple anomalies; 1.76 (1.18–2.63) with a chromosomal disorder; 2.19 (1.82–2.63) with hypospadias; 2.20 (1.51–3.21) with spina bifida; 2.39 (1.62–3.53) with congenital diaphragmatic hernia; 2.66 (2.27–3.13) with congenital heart disease; 3.15 (2.08–4.76) with omphalocele; and 3.27 (2.22–4.80) with anencephaly. Compared to pregnancies without fetal anomaly, all fetal anomalies were associated with an increased absolute risk of SMM except for gastroschisis and limb anomaly in order of aRDs (99% CI): 0.26 (0.12–0.40) with cleft lip and/or palate, 0.34 (0.13–0.55) with multiple anomalies, 0.34 (0.02–0.66) with a chromosomal disorder, 0.54 (0.36–0.72) with hypospadias, 0.54 (0.17–0.92) with spina bifida, 0.63 (0.21–1.05) with congenital diaphragmatic hernia, 0.75 (0.56–0.95) with congenital heart disease, 0.97 (0.38–1.56) with omphalocele, and 1.03 (0.46–1.59) with anencephaly.</p></div><div><h3>Conclusion</h3><p>The presence of fetal anomalies is associated with adverse maternal health outcomes. The risk of SMM varies according to the type of fetal anomaly. Counseling mothers about the maternal implications of fetal anomalies is paramount to help them make informed decisions regarding their pregnancy outcome.</p></div>\",\"PeriodicalId\":36186,\"journal\":{\"name\":\"American Journal of Obstetrics & Gynecology Mfm\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2024-07-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Obstetrics & Gynecology Mfm\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589933324001666\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Obstetrics & Gynecology Mfm","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589933324001666","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Maternal implications of fetal anomalies: a population-based cross-sectional study
Background
Although it is well-known that the presence of fetal anomalies is associated with maternal morbidity, granular information on these risks by type of anomaly is not available.
Objective
To examine adverse maternal outcomes according to the type of fetal anomaly.
Study Design
This was a repeated cross-sectional analysis of US vital statistics Live Birth/Infant Death linked data from 2011 to 2020. All pregnancies at 20 weeks or greater were included. Our primary outcome was severe maternal morbidity (SMM), defined as any maternal intensive care unit admission, transfusion, uterine rupture, or hysterectomy. Outcomes were compared between pregnancies with a specific type of fetal anomaly and pregnancies without any fetal anomaly. Fetal anomalies that were available in the dataset included anencephaly, meningomyelocele/spina bifida, cyanotic congenital heart disease, congenital diaphragmatic hernia, omphalocele, gastroschisis, cleft lip and/or palate, hypospadias, limb anomaly, and chromosomal disorders. If a fetus had more than one anomaly, it was classified as multiple anomalies. Adjusted relative risks (aRR) with 99% confidence intervals (99% CI) were calculated using modified Poisson regression. Adjusted risk differences (aRDs) were calculated using the marginal standardization form of predictive margins.
Results
Of 35,760,626 pregnancies included in the analysis, 35,655,624 pregnancies had no fetal anomaly and 105,002 had isolated or multiple fetal anomalies. Compared to pregnancies without fetal anomaly, all fetal anomalies were associated with an increased risk of SMM except for gastroschisis and limb anomaly in order of aRRs (99% CI): 1.58 (1.29–1.92) with cleft lip and/or palate; 1.75 (1.35–2.27) with multiple anomalies; 1.76 (1.18–2.63) with a chromosomal disorder; 2.19 (1.82–2.63) with hypospadias; 2.20 (1.51–3.21) with spina bifida; 2.39 (1.62–3.53) with congenital diaphragmatic hernia; 2.66 (2.27–3.13) with congenital heart disease; 3.15 (2.08–4.76) with omphalocele; and 3.27 (2.22–4.80) with anencephaly. Compared to pregnancies without fetal anomaly, all fetal anomalies were associated with an increased absolute risk of SMM except for gastroschisis and limb anomaly in order of aRDs (99% CI): 0.26 (0.12–0.40) with cleft lip and/or palate, 0.34 (0.13–0.55) with multiple anomalies, 0.34 (0.02–0.66) with a chromosomal disorder, 0.54 (0.36–0.72) with hypospadias, 0.54 (0.17–0.92) with spina bifida, 0.63 (0.21–1.05) with congenital diaphragmatic hernia, 0.75 (0.56–0.95) with congenital heart disease, 0.97 (0.38–1.56) with omphalocele, and 1.03 (0.46–1.59) with anencephaly.
Conclusion
The presence of fetal anomalies is associated with adverse maternal health outcomes. The risk of SMM varies according to the type of fetal anomaly. Counseling mothers about the maternal implications of fetal anomalies is paramount to help them make informed decisions regarding their pregnancy outcome.
期刊介绍:
The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including:
Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women.
Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health.
Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child.
Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby.
Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.