Adams M M, Elam-Evans L D, Wilson H G, Gilbertz D A
World Health Organization Collaborating Center in Perinatal Care and Health Services Research in Maternal Child Health, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
JAMA. 2000;283(12):1591-6. doi: 10.1001/jama.283.12.1591.
Information about risk of recurrent preterm delivery is useful to clinicians, researchers, and policy makers for counseling, generating etiologic leads, and measuring the related public health burden.
To identify the rate of recurrence of preterm delivery in second pregnancies, factors associated with recurrence, and the percentage of preterm deliveries in women with a history of preterm delivery.
Population-based cohort study of data from birth and fetal death certificates from the state of Georgia between 1980 and 1995.
A total of 122 722 white and 56174 black women with first and second singleton deliveries at 20 to 44 weeks' gestation.
Length of gestation (categorized as 20-31, 32-36, or > or =37 weeks) at second delivery compared with length of gestation at first delivery, by age and race.
Most women whose first delivery was preterm subsequently had term deliveries. Of 1023 white women whose first delivery occurred at 20 to 31 weeks, 8.2% (95% confidence interval [CI], 6.6%-10.1%) delivered their second birth at 20 to 31 weeks and 20.1% (95% CI, 17.7%-22.8%) at 32 to 36 weeks. Of 1084 comparable black women, 13.4% (95 % CI, 11.4%-15.6%) delivered at 20 to 31 weeks and 23.4% (95% CI, 20.9%-26.1%) delivered at 32 to 36 weeks. Among women whose first delivery occurred at 32 to 36 weeks, all corresponding rates were lower than those whose first birth was at 20 to 31 weeks; the rates of second birth at 20 to 31 weeks were substantially lower (for white women, 1.9% [95% CI, 1.7%-2.2%]; for black women, 3.8% [95% CI, 3.4%-4.2%]). Compared with women aged 20 to 49 years at their second delivery, women younger than 18 years had twice the risk of recurrence of delivery at 20 to 31 weeks. Of all second deliveries at 20 to 31 weeks, 29.4% for white women and 37.8% for black women were preceded by a preterm delivery.
Our data suggest that recurrence of preterm delivery contributes a notable portion of all preterm deliveries, especially at the shortest gestations.
复发性早产风险的信息对临床医生、研究人员和政策制定者在咨询、寻找病因线索以及衡量相关公共卫生负担方面很有用。
确定第二次妊娠时早产的复发率、与复发相关的因素以及有早产史女性中早产的百分比。
基于人群的队列研究，数据来自佐治亚州1980年至1995年的出生和胎儿死亡证明。
共有122722名白人女性和56174名黑人女性，她们分别有第一次和第二次单胎妊娠，妊娠周数为20至44周。
第二次分娩时的孕周（分为20 - 31周、32 - 36周或≥37周）与第一次分娩时的孕周相比，按年龄和种族划分。
大多数第一次分娩为早产的女性随后分娩的是足月产。在1023名第一次分娩发生在20至31周的白人女性中，8.2%（95%置信区间[CI]，6.6% - 10.1%）第二次分娩发生在20至31周，20.1%（95%CI，17.7% - 22.8%）发生在32至36周。在1084名可比的黑人女性中，13.4%（95%CI，11.4% - 15.6%）在20至31周分娩，23.4%（95%CI，20.9% - 26.1%）在32至36周分娩。在第一次分娩发生在32至36周的女性中，所有相应比例均低于第一次分娩发生在20至31周的女性；第二次分娩在20至31周的比例显著更低（白人女性为1.9%[95%CI，1.7% - 2.2%]；黑人女性为3.8%[95%CI，3.4% - 4.2%]）。与第二次分娩时年龄在20至49岁的女性相比，年龄小于18岁的女性在20至31周分娩复发的风险是前者的两倍。在所有20至31周的第二次分娩中，白人女性中有29.4%、黑人女性中有37.8%之前有过早产。
我们的数据表明，复发性早产在所有早产中占相当大的比例，尤其是在最短孕周时。
