P-305 Are there compensatory mechanisms in place to improve certain pregnancy complications in Black women with fibroid uteri? A study of more than 50,000 women
Notice bibliographique
Résumé
Abstract Study question Given how common uterine fibroids are in a black population we pondered if mechanisms were in place to decrease pregnancy complications? Summary answer Black women with fibroids had lower risks of gestational-diabetes, cesarean-sections and infants with congenital anomalies. Caucasians experienced lower rates of hypertensive-disorders, infections, among other complications. What is known already Black women have increased rates of most pregnancy complications when compared to white women in the USA, including risks of cesarean section, gestational diabetes, hypertensive disorders, post-partum hemorrhage, and transfusions, despite controlling for confounding effects including income, health status and illicit drug use. Uterine fibroids increase many pregnancies complication and are more common in Black women than Caucasians with a two to threefold increased risk. Study design, size, duration This retrospective population-based cohort study utilized data from the Healthcare-Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2010 to 2014, inclusively. There were 53340 pregnant women with uterine fibroids, 28,893 White and 24,447 Black, who underwent a delivery or maternal death. Participants/materials, setting, methods HCUP-NIS is the largest inpatient database in the USA and provides information relating to seven-million inpatient stays yearly, includes 20% of admissions, and represents over 96% of Americans. Multivariate logistic regression was conducted to explore associations between fibroids and Pregnancy outcomes delivery outcomes and Neonatal outcomes,while controlling for confounding effects. According to the Tri-Council Policy Statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Significant differences were observed in maternal characteristics including age-distribution, and income-quartiles-(p < 0.0001, all). Black women had higher rates of Medicaid, chronic-hypertension, obesity, pregestational -diabetes, illicit-drug use, tobacco-smoking, and HIV-(p < 0.0001, all). White women had higher cesarean section rates-(aOR:1.36, 95%CI:1.29-1.43, p < 0.0001) and lower risks of spontaneous vaginal deliveries-(aOR:0.72, 95%CI:0.69-0.77, p = 0.72), white women had also higher gestational diabetes-(aOR:1.10, 95%CI:1.03-1.19, p = 0.008), gestational hypertension-(aOR:1.12, 95%CI:1.01-1.23, p = 0.024) and higher congenital anomalies in white neonate-(aOR:2.78, 95%:2.21-3.49, p = 0.0001), when compared to Blacks. White women showed lower odds of: pregnancy-induced hypertension-(aOR:0.92, 95%CI:0.86-0.97, p = 0.005), preeclampsia-(aOR:0.86, 95%CI:0.79-0.94, p < 0.0001), eclampsia-(aOR:0.45, 95%CI: 0.22-0.93 p = 0.031), preeclampsia and eclampsia superimposed hypertension-(aOR:0.75, 95%CI:0.65-0.088, p < 0.0001), premature preterm rupture of membrane-(aOR:0.76, 95%CI:0.65-0.89, p < 0.001), preterm delivery-(aOR:0.68, 95%CI:0.63-0.73, p < 0.0001), chorioamnionitis-(aOR:0.85, 95%CI:0.74-0.98, p = 0.020), spontaneous vaginal deliveries-(aOR:0.72, 95%CI:0.69-0.77, p = 0.72), postpartum hemorrhage-(aOR:0.82, 95%CI:0.74-0.92, p = 0.001), blood transfusions-(aOR:0.49, 95%CI:0.43-0.57, p < 0.0001), maternal infections-(aOR:0.76, 95%CI:0.67-0.85, p = 0.0001) & small for gestational age neonates-(aOR:0.70, 95%CI:0.63-0.77, p < 0.0001), than Blacks. No significant differences were found in placenta previa-(aOR1.15, 95%CI:0.98-1.36, p = 0.094), abruptio placenta-(aOR:0.89, 95%CI:0.76-1.03, p = 0.126), operative vaginal delivery-(aOR:1.01, 95%CI:0.92-1.10, p = 0.906), Hysterectomy-(aOR:0.89, 95%CI:0.66-1.21, p = 0.450), wound complications-(aOR:1.06, 95%CI:0.85-1.32, p = 0.602), maternal deaths-(aOR:0.00, p = 0.959), DVT-(aOR:0.81, 95%CI:0.41-1.61, p = 0.552), pulmonary embolism-(aOR:0.64, 95%CI:0.19-1.13, p = 0.91), VTE-(aOR:0.67, 95%CI:0.93-1.53, p = 0.148), DIC-(aOR:0.92, 95%CI:0.68-1.26, p = 0.614), and intrauterine fetal death-(aOR:0.79, 95%CI:0.57-1.09, p = 0.153). Limitations, reasons for caution The limitations of our study are related to its retrospective nature and use of administrative database, which relies on the accuracy, and consistency of the individual coding the data. Wider implications of the findings Health-disparities exist when comparing black and white women with fibroids in pregnancy. However, the uteri of black women seem more tolerant as related to arrested labor and the need for cesarean sections and fetii with congenital anomalies. The mechanism lowering risks of GDM in black women with fibroids needs study. Trial registration number No
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».