严重孕产妇疾病定义比较：一项基于管理数据的全国队列研究
三种定义下严重孕产妇疾病发生率分别为1.4%、2.7%和1.1%，且种族与社会经济相对风险因定义不同而变化。
要点
- CDC、CPSS与EMMOI三种定义的严重孕产妇疾病发生率和风险差异明显，解读研究时需明确所用定义。
- 脓毒症是三种定义中最常见的构成要素，但多数病例仅有脓毒症编码而不伴休克编码。
- 采用不同定义会改变黑人与白人、最贫困与最不贫困地区之间的不平等程度估计。
核心结论
- 美国CDC不含输血、加拿大CPSS和英国EMMOI三种严重孕产妇疾病定义仅有中等一致性，会对种族和社会经济不平等的测量结果产生实质影响。
研究设计与样本
- 基于英格兰国家医疗服务体系管理数据的全国队列研究，纳入2013年1月1日至2023年3月31日分娩且出生孕周≥20周的孕产记录。
主要发现
- CDC与EMMOI、CPSS与EMMOI、CDC与CPSS的机遇校正一致性K值分别为0.67、0.50和0.52，三种定义联合一致性K值为0.55。
- 黑人女性相对白人女性的严重孕产妇疾病RR在CDC、CPSS和EMMOI定义下分别为1.96（95%CI 1.90–2.01）、1.71（95%CI 1.67–1.74）和1.98（95%CI 1.92–2.04）。
- 最贫困地区相对最不贫困地区女性的严重孕产妇疾病RR在CDC、CPSS和EMMOI定义下分别为1.37（95%CI 1.33–1.40）、1.18（95%CI 1.16–1.21）和1.22（95%CI 1.19–1.26）。
临床怎么用
- 临床和研究解读严重孕产妇疾病发生率及健康不平等数据时，应说明所采用的定义，并考虑定义差异对结论的影响。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT Objective To understand agreement between definitions of severe maternal morbidity (SMM), the reasons for disagreement and the impact the outcome definition may have on the measurement of ethnic and socioeconomic inequalities. Design A national cohort study using administrative data. Setting The English National Health Service. Population Maternities leading to birth between 1st January 2013 and 31st March 2023 at a gestational age at birth of ≥ 20 weeks. Methods The characteristics of maternities were described overall and according to SMM definition. Agreement and chance-adjusted agreement between definitions were calculated. Poisson regression was used to estimate relative risks (RRs) with 95% confidence intervals (95% CI) for SMM across ethnic and socioeconomic groups. Main Outcome Measures SMM definitions were the USA's Centers for Disease Control and Prevention (CDC) without blood transfusion, the Canadian Perinatal Surveillance System (CPSS) definition, and the English Maternal Morbidity Outcome Indicator (EMMOI). Results There were 5 939 919 included maternities. Overall, SMM occurred in 1.4% (80 191/5 939 919), 2.7% (158 759/5 939 919) and 1.1% (67 745/5 939 919) of maternities according to the CDC, CPSS and EMMOI definitions, respectively. Chance-adjusted agreement was K = 0.67 for the CDC and EMMOI; 0.50 for the CPSS and EMMOI; and 0.52 for the CDC and CPSS, with 0.55 between all three definitions. Ethnic and socioeconomic inequalities varied by definition, with RR 1.96 (95% CI 1.90–2.01), 1.71 (1.67–1.74) and 1.98 (1.92–2.04) for the CDC, CPSS and EMMOI definitions, respectively, for Black women compared to White, and RR 1.37 (1.33–1.40), 1.18 (1.16–1.21) and 1.22 (1.19–1.26), respectively, for women living in most vs. least deprived areas. Among maternities with SMM, 55% (44 193/80 191), 41% (64 982/158 759) and 35% (23 905/67 745) had a diagnostic code for sepsis within the CDC, CPSS and EMMOI definitions, respectively. Sepsis was the only component of the SMM indicator for 51%, 44% and 33% of maternities within each of the definitions, respectively. Only 0.3%–0.6% of sepsis codes were associated with a code for shock. The same percentages for acute renal failure overall were 18% (14 159/80 191), 9% (14 842/158 759), and 22% (14 842/67 745), respectively, with acute renal failure representing the only component of the SMM indicator for 13%, 5% and 17%, respectively. Only 1.1%–1.2% of renal failure codes were associated with a procedu
引用
- BJOG：Comparison of Definitions of Severe Maternal Morbidity: A National Cohort Study Using Administrative Data
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。