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Neurology:女性健康低潮需加强关注:合并神经系统合并症(WWN)女性初次分娩并发症机率、再入院率更高!

2022-03-15 Naomi MedSci原创

近日,有研究人员比较了患有常见神经系统合并症(WWN)的妇女和没有神经系统疾病的妇女的产科并发症和非选择性再入院的情况。WWN 患者在初次分娩时可能面临更高的产妇严重疾病风险、更高的产后再入院。

      在联合国千年发展目标中,减轻可预防的严重孕产妇疾病的倡议仍然是全球医疗保健的首要优先事项。然而,最近的报告表明进展不足。患有神经系统合并症(WWN)的妇女在怀孕期间是一个弱势群体。患有癫痫等特定神经系统合并症的孕妇在分娩时极有可能出现不良后果,包括产妇死亡。不幸的是,认识到产妇发病率和死亡率的真实规模仍然是一个具有挑战性的障碍,因为报告、错误分类和缺乏适当的监测使这一问题的范围变得模糊。

      虽然之前的研究表明,患有某些神经系统疾病的妇女在怀孕期间发生产科并发症的风险更高,但WWN对围产期和产后结局的全国性估计并未定期报道。发现特定的母体并发症在患有神经系统合并症的妇女中更为普遍,这可能会导致关于妊娠和产后神经系统疾病的病理生理学的新的可检验的假说。孕妇WWN对医疗保健接口和资源利用的更多了解对于创建多学科临床基础设施和可能优化母婴结局的医疗保健提供范例也是至关重要的。

      由于缺乏关于神经系统疾病女性的全国围产期和产后结局文献,有研究人员对癫痫女性患者的这些发现进行了评估。先前的研究证明,母亲癫痫与疾病控制和预防中心 (CDC) 严重母亲发病率 (SMM) 指标的更大几率和更高的非选择性短期产后再入院率相关。近日,有研究人员比较了患有常见神经系统合并症(WWN)的妇女和没有神经系统疾病的妇女的产科并发症和非选择性再入院的情况。

      采用国际疾病分类第10次修订编码,对2015-2017年全国再入院数据库中的指标特征和急性产后非选择性再住院进行回顾性队列研究。Wald卡方检验比较WWN[包括既往卒中、偏头痛、多发性硬化症(MS)和重症肌无力(MG)]和对照组之间的基线人口学、医院、临床特征和产后并发症。与对照组相比,多变量Logistic回归模型检测了每种神经系统共病在30天和90天内发生产后并发症和非选择性再住院的几率(α=0.05)。

  • 共有 7,612 名既往卒中妇女、83,430 名偏头痛妇女、6,760 名 MS 妇女、843 名 MG 妇女和 8,136,335 名对照者在活产婴儿分娩后符合入院标准。
  • 与对照组相比,WWN 更有可能被诊断为水肿、蛋白尿、高血压疾病的住院诊断,并因胎儿生长不良而接受母体护理。
  • 疾病控制和预防中心 (CDC) 严重孕产妇发病率指标 (SMM) 的调整几率对于既往卒中的女性更高:AOR 8.53, 95% CI 7.24-10.06,偏头痛:AOR 2.04, 95% CI 1.85-2.26 和 MG:AOR 4.45, 95% CI 2.45-8.08(所有 p<0.0001)。
  • WWN 在 30 天和 90 天的再入院率高于对照组(30 天:既往卒中 2.9%,偏头痛 1.7%,MS 1.8%,MG 4.3%,对照组 1.1%;90 天:既往卒中 3.7%,偏头痛 2.5%, MS 5.1%,MG 6.0%,对照 1.6%)。
  • 患有 MG 的女性再次入院的调整后几率最高(30 天:AOR 3.96,95% CI 2.37-6.65,p<0.0001;90 天:AOR 3.30,95% CI 1.88-5.78,p<0.0001)。

      WWN 在初次分娩时可能面临更高的产妇严重疾病风险、更高的产后再入院。 需要更多真实世界的证据来发展研究基础设施并制定有效的干预措施以优化 WWN 中的母胎结局,尤其是对于既往有卒中或 MG 的孕妇。

文献来源:McElwee Decker B, Thibault D, Davis KA, Willis AW. Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis [published online ahead of print, 2022 Feb 15]. Neurology. 2022;10.1212/WNL.0000000000200007. doi:10.1212/WNL.0000000000200007

 

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    2022-03-20 yinhl1978
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    2022-08-16 丁鹏鹏
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    2022-03-11 linlin2312
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