Abstract：
BACKGROUND: Most patients with signs or symptoms (s/s) of suspected preeclampsia are not diagnosed with preeclampsia. We sought to determine and compare the prevalence of s/s, pregnancy outcomes, and costs between patients with and without diagnosed preeclampsia.
METHODS: This retrospective cohort study analyzed a large insurance research database. Pregnancies with s/s of preeclampsia versus a confirmed preeclampsia diagnosis were identified using International Classification of Diseases codes. S/s include hypertension, proteinuria, headache, visual symptoms, edema, abdominal pain, and nausea/vomiting. Pregnancies were classed as 1) s/s of preeclampsia without a confirmed preeclampsia diagnosis (suspicion only), 2) s/s with a confirmed diagnosis (preeclampsia with suspicion), 3) diagnosed preeclampsia without s/s recorded (preeclampsia only), and 4) no s/s, nor preeclampsia diagnosis (control).
RESULTS: Of 1,324,424 pregnancies, 29.2 % had ≥1 documented s/s of suspected preeclampsia, and 14.2 % received a preeclampsia diagnosis. Hypertension and headache were the most common s/s, leading 20.2 % and 9.2 % pregnancies developed to preeclampsia diagnosis, respectively. Preeclampsia, with or without suspicion, had the highest rates of hypertension-related severe maternal morbidity (HR [95 % CI]: 3.0 [2.7, 3.2] and 3.6 [3.3, 4.0], respectively) versus controls. A similar trend was seen in neonatal outcomes such as preterm delivery and low birth weight. Cases in which preeclampsia was suspected but not confirmed had the highest average total maternal care costs ($6096 [95 % CI: 602, 6170] over control).
CONCLUSIONS: There is a high prevalence but poor selectivity of traditional s/s of preeclampsia, highlighting a clinical need for improved screening method and cost-effectiveness disease management.
METHODS: This retrospective cohort study analyzed a large insurance research database. Pregnancies with s/s of preeclampsia versus a confirmed preeclampsia diagnosis were identified using International Classification of Diseases codes. S/s include hypertension, proteinuria, headache, visual symptoms, edema, abdominal pain, and nausea/vomiting. Pregnancies were classed as 1) s/s of preeclampsia without a confirmed preeclampsia diagnosis (suspicion only), 2) s/s with a confirmed diagnosis (preeclampsia with suspicion), 3) diagnosed preeclampsia without s/s recorded (preeclampsia only), and 4) no s/s, nor preeclampsia diagnosis (control).
RESULTS: Of 1,324,424 pregnancies, 29.2 % had ≥1 documented s/s of suspected preeclampsia, and 14.2 % received a preeclampsia diagnosis. Hypertension and headache were the most common s/s, leading 20.2 % and 9.2 % pregnancies developed to preeclampsia diagnosis, respectively. Preeclampsia, with or without suspicion, had the highest rates of hypertension-related severe maternal morbidity (HR [95 % CI]: 3.0 [2.7, 3.2] and 3.6 [3.3, 4.0], respectively) versus controls. A similar trend was seen in neonatal outcomes such as preterm delivery and low birth weight. Cases in which preeclampsia was suspected but not confirmed had the highest average total maternal care costs ($6096 [95 % CI: 602, 6170] over control).
CONCLUSIONS: There is a high prevalence but poor selectivity of traditional s/s of preeclampsia, highlighting a clinical need for improved screening method and cost-effectiveness disease management.
摘要：
背景：大多数具有疑似先兆子痫体征或症状（s/s）的患者未被诊断为先兆子痫。我们试图确定和比较s/s的患病率，妊娠结局,以及患有和未诊断为先兆子痫的患者之间的费用。
方法：这项回顾性队列研究分析了一个大型保险研究数据库。使用国际疾病分类代码鉴定具有先兆子痫的妊娠与确认的先兆子痫诊断。S/S包括高血压，蛋白尿,头痛,视觉症状,水肿,腹痛,恶心/呕吐。妊娠被归类为1）s/s先兆子痫，但未确诊先兆子痫（仅怀疑），2）s/s确诊（怀疑先兆子痫），3）诊断为先兆子痫，无s/s记录（仅先兆子痫），和4)无s/s，也没有先兆子痫诊断（对照）。
结果：在1,324,424例怀孕中，29.2%有≥1s/s的可疑先兆子痫，14.2%诊断为先兆子痫.高血压和头痛是最常见的S/S，导致20.2%和9.2%的妊娠发展为先兆子痫诊断，分别。先兆子痫,不管有没有怀疑，与高血压相关的严重孕产妇发病率最高(HR[95%CI]:3.0[2.7,3.2]和3.6[3.3,4.0],分别)与控制。在早产和低出生体重等新生儿结局中也看到了类似的趋势。怀疑有先兆子痫但未确诊的病例的平均产妇护理总费用最高（对照组为6096美元[95%CI:602,6170]）。
结论：先兆子痫的传统流行率很高，但选择性差，强调临床需要改进筛查方法和成本效益的疾病管理。
方法：这项回顾性队列研究分析了一个大型保险研究数据库。使用国际疾病分类代码鉴定具有先兆子痫的妊娠与确认的先兆子痫诊断。S/S包括高血压，蛋白尿,头痛,视觉症状,水肿,腹痛,恶心/呕吐。妊娠被归类为1）s/s先兆子痫，但未确诊先兆子痫（仅怀疑），2）s/s确诊（怀疑先兆子痫），3）诊断为先兆子痫，无s/s记录（仅先兆子痫），和4)无s/s，也没有先兆子痫诊断（对照）。
结果：在1,324,424例怀孕中，29.2%有≥1s/s的可疑先兆子痫，14.2%诊断为先兆子痫.高血压和头痛是最常见的S/S，导致20.2%和9.2%的妊娠发展为先兆子痫诊断，分别。先兆子痫,不管有没有怀疑，与高血压相关的严重孕产妇发病率最高(HR[95%CI]:3.0[2.7,3.2]和3.6[3.3,4.0],分别)与控制。在早产和低出生体重等新生儿结局中也看到了类似的趋势。怀疑有先兆子痫但未确诊的病例的平均产妇护理总费用最高（对照组为6096美元[95%CI:602,6170]）。
结论：先兆子痫的传统流行率很高，但选择性差，强调临床需要改进筛查方法和成本效益的疾病管理。
