4 years ago

Maternal and neonatal outcomes of pregnancies in women with Addison's disease: a population-based cohort study on 7.7 million births

AR Spence, HA Abenhaim, M Schneiderman, N Czuzoj-Shulman
Objective To assess if pregnancies among women with Addison's disease (AD) are at higher risk of adverse maternal and neonatal outcomes. Design Population-based retrospective cohort study. Setting/Population All births in the United States’ Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. Methods Baseline characteristics were compared between women with AD and those without, and prevalence over time was measured. Logistic regression was used to estimate the effect of AD on maternal and neonatal outcomes by calculating the crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI). Results We calculated a prevalence of AD in pregnancy of 5.5/100 000, increasing from 5.6 to 9.6/100 000 (P = 0.0001) over the 9-year study period. Compared with women without AD, women with AD were more likely to deliver preterm (OR 1.50, 95% CI 1.16–1.95), deliver by caesarean section (OR 1.32, 95% CI 1.08–1.61), have impaired wound healing (OR 4.28, 95% CI 2.55–7.18), develop infections (OR 2.44, 95% CI 1.66–3.58) and develop thromboembolism (OR 5.21, 95% CI 2.15–12.63), require transfusions (OR 6.69, 95% CI 4.69–9.54), and have prolonged postpartum hospital admissions (OR 5.71, 95% CI 4.37–7.47). Maternal mortality was significantly higher than in the comparison group (OR 22.30, 95% CI 6.82–72.96). Congenital anomalies (OR 3.62, 95% CI 2.05–6.39) and small-for-gestational age infants (OR 1.78, 95% CI 1.15–2.75) were more likely in these pregnancies. Conclusions Addison's disease significantly increases the risk of severe adverse maternal and neonatal outcomes, so pregnant women with AD are best managed in tertiary-care centres. Tweetable abstract Pregnancies complicated by Addison's disease have an increased risk of adverse maternal and neonatal outcomes.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/1471-0528.14448

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