Assessment of obstetric characteristics and outcomes associated with pregnancy with Turner syndrome

Objective: To assess national-level trends, characteristics, and outcomes of pregnancies with Turner syndrome in the United States. Design: Cross-sectional study. Setting: The Healthcare Cost and Utilization Project's National Inpatient Sample. Subjects: A total of 17,865,495 hospital deliveries from 2016-2020. - 2020. Exposure: A diagnosis of Turner syndrome, identified fi ed according to the World Health Organization's International Classification fi cation of Disease 10th revision code of Q96. Main Outcome Measures: Obstetrics outcomes related to Turner syndrome, assessed with inverse probability of treatment weighting cohort and multivariable binary logistic regression modeling. Results: The prevalence of pregnant patients with Turner syndrome was 7.0 per 100,000 deliveries (one in 14,235). The number of hospital deliveries with patients who have a diagnosis of Turner syndrome increased from 5.0 to 11.7 per 100,000 deliveries during the study period (adjusted-odds ratio [aOR] for 2020 vs. 2016; 2.18, 95% confidence fi dence interval [CI] 1.83-2.60). - 2.60). Pregnant patients with Turner syndrome were more likely to have a diagnosis of pregestational hypertension (4.8% vs. 2.8%; aOR 1.65; 95% CI 1.26-2.15), - 2.15), uterine anomaly (1.6% vs. 0.4%; aOR, 3.01; 95% CI 1.93-4.69), - 4.69), and prior pregnancy losses (1.6% vs. 0.3%; aOR 4.70; 95% CI 3.01-7.32) - 7.32) compared with those without Turner syndrome. For the index obstetric characteristics, Turner syndrome was associated with an increased risk of intrauterine fetal demise (10.9% vs. 0.7%; aOR 8.40; 95% CI 5.30-13.30), - 13.30), intrauterine growth restriction (8.5% vs. 3.5%; aOR 2.11; 95% CI 1.48-2.99), - 2.99), and placenta accreta spectrum (aOR 3.63; 95% CI 1.20-10.97). - 10.97). For delivery outcome, pregnant patients with Turner syndrome were more likely to undergo cesarean delivery (41.6% vs. 32.3%; aOR 1.53; 95% CI 1.26-1.87). - 1.87). Moreover, the odds of periviable delivery (22-25 - 25 weeks: 6.1% vs. 0.4%; aOR 5.88; 95% CI 3.47-9.98) - 9.98) and previable delivery (<22 < 22 weeks: 3.3% vs. 0.3%; aOR 2.87; 95% CI 1.45-5.69) - 5.69) were increased compared with those without Turner syndrome. Conclusions: The results of contemporaneous, nationwide assessment in the United States suggest that although pregnancy with Turner syndrome is uncommon this may represent a high-risk group, particularly for intrauterine fetal demise and periviable delivery. Establishing a society-based approach for preconception counseling and antenatal follow-up would be clinically compelling. (c) 2024 by American Society for Reproductive Medicine.)