Anaphylaxis in Pregnancy in the United States: Risk Factors and Temporal Trends Using National Routinely Collected Data

S.J. McCall, Jennifer J Kurinczuk, Marian Knight

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)

Abstract

Background
Anaphylaxis in pregnancy is an understudied, rare, and severe complication of pregnancy.

Objective
To describe the incidence and temporal trends, and to identify potential risk factors for anaphylaxis-related hospitalizations while pregnant in the United States.

Methods
All hospitalizations while pregnant and any anaphylactic reactions were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes from the National Inpatient Sample, United States, over the period 2004 to 2014. Annual incidence rates of anaphylaxis during pregnancy were calculated. Logistic regression models assessed risk factors for anaphylaxis during pregnancy, presented as odds ratios (ORs) and 95% CIs.

Results
During the period 2004 to 2014, the incidence of anaphylaxis during pregnancy was 3.8 (95% CI, 3.4-4.2) per 100,000 hospitalizations while pregnant. The incidence did not statistically differ during the period 2004 to 2014. After adjustment, there were 3 factors that increased the odds of anaphylaxis during pregnancy: cesarean delivery (adjusted OR [aOR], 4.19; 95% CI, 3.28-5.35) compared with noncesarean delivery; history of an allergic reaction (aOR, 4.05; 95% CI, 2.64-6.23) compared with no history; and a black race (aOR, 1.57; 95% CI, 1.15-2.15) and other race (aOR, 1.69; 95% CI, 1.08-2.63) compared with white race.

Conclusions
Despite increased rates of cesarean delivery in the United States and consequent drug administration, there was no evidence of an increasing trend in anaphylaxis. Cesarean delivery and history of an allergic reaction allow the identification of women at risk of anaphylaxis. Not all women had clear risk factors, and preparations should always be in place to ensure timely management if this uncommon event occurs.
Original languageEnglish
Pages (from-to)2606-2612
Number of pages10
JournalJournal of Allergy and Clinical Immunology: In Practice
Early online date16 May 2019
DOIs
Publication statusPublished - Dec 2019

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