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

doi:10.1016/j.jaip.2019.04.047

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

S.J. McCall^* (Corresponding Author), Jennifer J Kurinczuk, Marian Knight

^*Corresponding author for this work

University of Oxford

Research output: Contribution to journal › Article › peer-review

15 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 language	English
Pages (from-to)	2606-2612
Number of pages	10
Journal	Journal of Allergy and Clinical Immunology: In Practice
Volume	7
Issue number	8
Early online date	6 Nov 2019
DOIs	https://doi.org/10.1016/j.jaip.2019.04.047
Publication status	Published - Dec 2019

Bibliographical note

Acknowledgments
List of Healthcare Cost and Utilization Project Data Partners: Alaska Department of Health and Social Services, Alaska State Hospital and Nursing Home Association, Arizona Department of Health Services, Arkansas Department of Health, California Office of Statewide Health Planning and Development, Colorado Hospital Association, Connecticut Hospital Association, Delaware Division of Public Health, District of Columbia Hospital Association, Florida Agency for Health Care Administration, Georgia Hospital Association, Hawaii Health Information Corporation, Illinois Department of Public Health, Indiana Hospital Association, Iowa Hospital Association, Kansas Hospital Association, Kentucky Cabinet for Health and Family Services, Louisiana Department of Health, Maine Health Data Organization, Maryland Health Services Cost Review Commission, Massachusetts Center for Health Information and Analysis, Michigan Health & Hospital Association, Minnesota Hospital Association (provides data for Minnesota and North Dakota Hospitals), Mississippi State Department of Health, Missouri Hospital Industry Data Institute, Montana Hospital Association, Nebraska Hospital Association, Nevada Department of Health and Human Services, New Hampshire Department of Health & Human Services, New Jersey Department of Health, New Mexico Department of Health, New York State Department of Health, North Carolina Department of Health and Human Services, North Dakota (data provided by the Minnesota Hospital Association), Ohio Hospital Association, Oklahoma State Department of Health, Oregon Office of Health Analytics, Oregon Association of Hospitals and Health Systems, Pennsylvania Health Care Cost Containment Council, Rhode Island Department of Health, South Carolina Revenue and Fiscal Affairs Office, South Dakota Association of Healthcare Organizations, Tennessee Hospital Association, Texas Department of State Health Services, Utah Department of Health, Vermont Association of Hospitals and Health Systems, Virginia Health Information, Washington State Department of Health, West Virginia Department of Health and Human Resources, West Virginia Health Care Authority, Wisconsin Department of Health Services, and Wyoming Hospital Association.

Keywords

Anaphylaxis
Pregnancy
Cesarean section
Risk factors

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Cite this

@article{99b9f1603f4c4f06a20e33034bf047cb,

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

abstract = "BackgroundAnaphylaxis in pregnancy is an understudied, rare, and severe complication of pregnancy.ObjectiveTo describe the incidence and temporal trends, and to identify potential risk factors for anaphylaxis-related hospitalizations while pregnant in the United States.MethodsAll 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.ResultsDuring 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.ConclusionsDespite 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.",

keywords = "Anaphylaxis, Pregnancy, Cesarean section, Risk factors",

author = "S.J. McCall and Kurinczuk, {Jennifer J} and Marian Knight",

note = "Acknowledgments List of Healthcare Cost and Utilization Project Data Partners: Alaska Department of Health and Social Services, Alaska State Hospital and Nursing Home Association, Arizona Department of Health Services, Arkansas Department of Health, California Office of Statewide Health Planning and Development, Colorado Hospital Association, Connecticut Hospital Association, Delaware Division of Public Health, District of Columbia Hospital Association, Florida Agency for Health Care Administration, Georgia Hospital Association, Hawaii Health Information Corporation, Illinois Department of Public Health, Indiana Hospital Association, Iowa Hospital Association, Kansas Hospital Association, Kentucky Cabinet for Health and Family Services, Louisiana Department of Health, Maine Health Data Organization, Maryland Health Services Cost Review Commission, Massachusetts Center for Health Information and Analysis, Michigan Health & Hospital Association, Minnesota Hospital Association (provides data for Minnesota and North Dakota Hospitals), Mississippi State Department of Health, Missouri Hospital Industry Data Institute, Montana Hospital Association, Nebraska Hospital Association, Nevada Department of Health and Human Services, New Hampshire Department of Health & Human Services, New Jersey Department of Health, New Mexico Department of Health, New York State Department of Health, North Carolina Department of Health and Human Services, North Dakota (data provided by the Minnesota Hospital Association), Ohio Hospital Association, Oklahoma State Department of Health, Oregon Office of Health Analytics, Oregon Association of Hospitals and Health Systems, Pennsylvania Health Care Cost Containment Council, Rhode Island Department of Health, South Carolina Revenue and Fiscal Affairs Office, South Dakota Association of Healthcare Organizations, Tennessee Hospital Association, Texas Department of State Health Services, Utah Department of Health, Vermont Association of Hospitals and Health Systems, Virginia Health Information, Washington State Department of Health, West Virginia Department of Health and Human Resources, West Virginia Health Care Authority, Wisconsin Department of Health Services, and Wyoming Hospital Association.",

year = "2019",

month = dec,

doi = "10.1016/j.jaip.2019.04.047",

language = "English",

volume = "7",

pages = "2606--2612",

journal = "Journal of Allergy and Clinical Immunology: In Practice",

issn = "2213-2198",

publisher = "Elsevier",

number = "8",

}

TY - JOUR

T1 - Anaphylaxis in Pregnancy in the United States

T2 - Risk Factors and Temporal Trends Using National Routinely Collected Data

AU - McCall, S.J.

AU - Kurinczuk, Jennifer J

AU - Knight, Marian

N1 - Acknowledgments List of Healthcare Cost and Utilization Project Data Partners: Alaska Department of Health and Social Services, Alaska State Hospital and Nursing Home Association, Arizona Department of Health Services, Arkansas Department of Health, California Office of Statewide Health Planning and Development, Colorado Hospital Association, Connecticut Hospital Association, Delaware Division of Public Health, District of Columbia Hospital Association, Florida Agency for Health Care Administration, Georgia Hospital Association, Hawaii Health Information Corporation, Illinois Department of Public Health, Indiana Hospital Association, Iowa Hospital Association, Kansas Hospital Association, Kentucky Cabinet for Health and Family Services, Louisiana Department of Health, Maine Health Data Organization, Maryland Health Services Cost Review Commission, Massachusetts Center for Health Information and Analysis, Michigan Health & Hospital Association, Minnesota Hospital Association (provides data for Minnesota and North Dakota Hospitals), Mississippi State Department of Health, Missouri Hospital Industry Data Institute, Montana Hospital Association, Nebraska Hospital Association, Nevada Department of Health and Human Services, New Hampshire Department of Health & Human Services, New Jersey Department of Health, New Mexico Department of Health, New York State Department of Health, North Carolina Department of Health and Human Services, North Dakota (data provided by the Minnesota Hospital Association), Ohio Hospital Association, Oklahoma State Department of Health, Oregon Office of Health Analytics, Oregon Association of Hospitals and Health Systems, Pennsylvania Health Care Cost Containment Council, Rhode Island Department of Health, South Carolina Revenue and Fiscal Affairs Office, South Dakota Association of Healthcare Organizations, Tennessee Hospital Association, Texas Department of State Health Services, Utah Department of Health, Vermont Association of Hospitals and Health Systems, Virginia Health Information, Washington State Department of Health, West Virginia Department of Health and Human Resources, West Virginia Health Care Authority, Wisconsin Department of Health Services, and Wyoming Hospital Association.

PY - 2019/12

Y1 - 2019/12

N2 - BackgroundAnaphylaxis in pregnancy is an understudied, rare, and severe complication of pregnancy.ObjectiveTo describe the incidence and temporal trends, and to identify potential risk factors for anaphylaxis-related hospitalizations while pregnant in the United States.MethodsAll 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.ResultsDuring 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.ConclusionsDespite 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.

AB - BackgroundAnaphylaxis in pregnancy is an understudied, rare, and severe complication of pregnancy.ObjectiveTo describe the incidence and temporal trends, and to identify potential risk factors for anaphylaxis-related hospitalizations while pregnant in the United States.MethodsAll 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.ResultsDuring 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.ConclusionsDespite 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.

KW - Anaphylaxis

KW - Pregnancy

KW - Cesarean section

KW - Risk factors

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U2 - 10.1016/j.jaip.2019.04.047

DO - 10.1016/j.jaip.2019.04.047

M3 - Article

SN - 2213-2198

VL - 7

SP - 2606

EP - 2612

JO - Journal of Allergy and Clinical Immunology: In Practice

JF - Journal of Allergy and Clinical Immunology: In Practice

IS - 8

ER -

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

Abstract

Bibliographical note

Keywords

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