Severe maternal morbidity and risk of adverse pregnancy, delivery, and neonatal outcomes in the subsequent delivery
Notice bibliographique
Résumé
BACKGROUND: Severe maternal morbidity is associated with substantially increased risks of adverse neonatal outcomes. However, few studies have assessed the association between severe maternal morbidity and adverse pregnancy, delivery, and perinatal outcomes in the subsequent delivery. OBJECTIVE: We aimed to investigate the association between severe maternal morbidity and its specific types in the first delivery and the risk of adverse pregnancy, delivery, and neonatal outcomes in the second delivery. STUDY DESIGN: We examined 2 population-based cohorts in Sweden and British Columbia, Canada, of mothers with both their first and second delivery recorded. The primary exposure was severe maternal morbidity in the first delivery (recorded during pregnancy, delivery or within 42 days postpartum). The outcomes were pregnancy and delivery complications, and offspring composite severe neonatal morbidity, and perinatal mortality (ie, stillbirths or neonatal deaths) within the first 28 days after birth, in the second delivery. We used multivariable generalized linear models to obtain adjusted risk ratios and 95% confidence intervals, adjusted for confounders. RESULTS: In both Sweden and British Columbia, women who experienced severe maternal morbidity in their first delivery had an increased risk of composite perinatal death/severe neonatal morbidity in the second delivery (Sweden: adjusted risk ratio, 1.88; 95% confidence interval, 1.75-2.02, British Columbia: adjusted risk ratio, 1.49; 95% confidence interval, 1.24-1.79), compared with mothers without severe maternal morbidity in the first delivery. In Sweden, second deliveries to women who had severe maternal morbidity in their first delivery were associated with a 1.59-times higher risk of stillbirth, a 1.65-times higher risk of neonatal mortality, a 1.95-times higher risk of composite severe neonatal morbidity, and 1.69-fold higher risk of infant mortality. In Sweden, compared with unaffected first delivery, severe maternal morbidity in the first delivery was associated with a 4.77-fold higher risk of severe maternal morbidity, 6.20-fold higher risk of preeclampsia, and an approximately 2-fold increased risk of placental abruption, maternal infection, antepartum hemorrhage, and postpartum hemorrhage in the second delivery. While in British Columbia, the adjusted estimates were in the same direction as in Sweden, statistical significance was reached for several outcomes, specifically, infant mortality, severe maternal morbidity, preeclampsia, gestational diabetes, placental abruption, antepartum hemorrhage, postpartum hemorrhage, and both elective and cesarean delivery in the second delivery. CONCLUSION: In both Sweden and British Columbia, Canada, severe maternal morbidity in the first delivery was associated with an increased risk of adverse pregnancy, delivery, and offspring outcomes in the subsequent delivery. Our findings can guide clinical and reproductive counseling for women with a history of severe maternal morbidity.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 source (Gemma direct ou Codex distillé), 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 ».