Delivery-Related Maternal Morbidity and Mortality Among Patients With Cardiac Disease.

To assess the risk of severe maternal morbidity (SMM) and mortality among pregnant patients with cardiovascular disease (CVD). This was a retrospective cohort study of U.S. delivery hospitalizations from 2010 to 2020 using weighted population estimates from the National Inpatient Sample database. The primary objective was to evaluate the risk of SMM and maternal mortality among patients with CVD at delivery hospitalization. International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations, CVD, and SMM events. Multivariable logistic regression analyses were performed to compare SMM and mortality risk among patients with CVD and those without CVD. Given the substantial racial and ethnic disparities in SMM, mortality, and CVD burden, secondary objectives included evaluating SMM and mortality across racial and ethnic groups and assessing the population attributable fraction within each group. Lastly, subgroup analyses of SMM by underlying CVD diagnoses (eg, congenital heart disease, chronic heart failure) were performed. Variables used in the regression models included socioeconomic and demographic maternal characteristics, maternal comorbidities, and pregnancy-specific complications. Among 38,374,326 individuals with delivery hospitalizations, 203,448 (0.5%) had CVD. Patients with CVD had an increased risk of SMM (11.6 vs 0.7%, adjusted odds ratio [aOR] 12.5, 95% CI, 12.0-13.1) and maternal death (538 vs 5 per 100,000 delivery hospitalizations, aOR 44.1, 95% CI, 35.4-55.0) compared with those without CVD. Patients with chronic heart failure had the highest SMM risk (aOR 354.4, 95% CI, 301.0-417.3) among CVD categories. Black patients with CVD had a higher risk of SMM (aOR 15.9, 95% CI, 14.7-17.1) than those without CVD with an adjusted population attributable fraction of 10.5% (95% CI, 10.0-11.0%). CVD in pregnancy is associated with increased risk of SMM and mortality, with the highest risk of SMM among patients with chronic heart failure. Although CVD affects less than 1% of the pregnant population, it contributes to nearly 1 in 10 SMM events in the United States.

Toledo I ，Czarny H ，DeFranco E ，Warshak C ，Rossi R ... -  《-》

Substance use disorder and severe maternal morbidity: is there a differential impact?

Substance use disorder (SUD) is a disease characterized by behavior patterns of substance use leading to dysfunction in cognition, mood, and quality of life. The prevalence of perinatal SUD in the United States continues to rise and has adverse effects on the maternal-infant dyad. Mirroring the rise in SUD is an increasing prevalence of severe maternal morbidity (SMM). However, this relationship needs further examination. The primary objective of this study was to evaluate the association between perinatal SUD and SMM. We hypothesized that SUD would predict a significantly increased risk for SMM events, both as a composite and individually, in adjusted multivariable regression analyses. We conducted a cross-sectional analysis of inpatient pregnancy hospitalizations from the Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2020. ICD-10 codes were used to identify patients with an SUD and/or a SMM event. SUD was defined as a composite. Our primary outcome was rate of SMM as defined by the Centers for Disease Control and Prevention. Multivariable logistic regression analyses were performed to predict the likelihood of SMM among pregnancy hospitalizations with and without SUD as well as to predict the likelihood of SMM for each individual type of SUD in a subgroup of hospitalizations with SUD and SMM. Of the 3672,932 inpatient pregnancy hospitalizations included in the analyses, 6.27% (230,110/3,672,932) had SUD diagnosis and 2.10% (77,021/3,672,932) had an SMM diagnosis. The prevalence of SMM was significantly higher among patients with SUD (7357/230,110%-3.20%) vs without SUD (69,664/3442,822-2.02%, P<.0001). Patients with SUD were 1.5 times more likely to have a SMM event as compared to those without SUD (aOR 1.52; 95% CI 1.48-1.56). In subgroup analyses based on SUD type-the likelihood of SMM was strongest for stimulants (aOR 3.86; 95% CI 3.61-4.13) and sedatives (aOR 3.82; 95% CI 3.08-4.75). In subgroup analyses based on SMM event, SUD was a strong positive predictor for acute myocardial infarction (aOR 3.63; 95% CI 2.78-4.74) and aneurysm (aOR 6.28; 95% CI 2.77-14.21). Pregnant patients with SUD carry significantly increased risk of experiencing an SMM event. These events occur more readily in patients with certain patterns of SUD use-most notably sedatives and stimulants. Patients with SUD were most likely to experience a cardiovascular-related SMM event, thus informing care.

Keller JM ，Al-Hammadi N ，Bass S ，Chavan NR ... -  《-》

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling.

Elwenspoek MM ，Thom H ，Sheppard AL ，Keeney E ，O'Donnell R ，Jackson J ，Roadevin C ，Dawson S ，Lane D ，Stubbs J ，Everitt H ，Watson JC ，Hay AD ，Gillett P ，Robins G ，Jones HE ，Mallett S ，Whiting PF ... -  《-》

Laboratory-Confirmed Influenza-Associated Hospitalizations Among Children and Adults - Influenza Hospitalization Surveillance Network, United States, 2010-2023.

Naquin A ，O'Halloran A ，Ujamaa D ，Sundaresan D ，Masalovich S ，Cummings CN ，Noah K ，Jain S ，Kirley PD ，Alden NB ，Austin E ，Meek J ，Yousey-Hindes K ，Openo K ，Witt L ，Monroe ML ，Henderson J ，Nunez VT ，Lynfield R ，McMahon M ，Shaw YP ，McCahon C ，Spina N ，Engesser K ，Tesini BL ，Gaitan MA ，Shiltz E ，Lung K ，Sutton M ，Hendrick MA ，Schaffner W ，Talbot HK ，George A ，Zahid H ，Reed C ，Garg S ，Bozio CH ... -  《MMWR SURVEILLANCE SUMMARIES》

Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021.

Gentzke AS ，Wang TW ，Cornelius M ，Park-Lee E ，Ren C ，Sawdey MD ，Cullen KA ，Loretan C ，Jamal A ，Homa DM ... -  《MMWR SURVEILLANCE SUMMARIES》