Smulian John C, Ananth Cande V, Vintzileos Anthony M, Scorza William E, Knuppel Robert A
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Brunswick 08903, USA.
Obstet Gynecol. 2002 Dec;100(6):1183-9. doi: 10.1016/s0029-7844(02)02389-x.
To estimate the effect of specific maternal-fetal high-risk conditions on the risk and timing of fetal death.
This study examined 10,614,679 non-anomalous singleton pregnancies delivering at or beyond 24 weeks' gestation, derived from the U.S. linked birth/infant death data sets, 1995-1997. Fetal death rates for pregnancies at low risk were compared with pregnancies complicated by chronic hypertension, gestational hypertensive disorders, diabetes, small for gestational age infants, and abruption. Adjusted relative risks as well as population-attributable risks for fetal death were derived by gestational age for each high-risk condition compared with low-risk pregnancies.
The fetal death rate for low-risk pregnancies was 1.6 per 1000 births. Adjusted relative risk for fetal death was 9.2 (95% confidence interval [CI] 8.8, 9.7) for abruption, 7.0 (95% CI 6.8, 7.2) for small for gestational age infants, 1.4 (95% CI 1.3, 1.5) for gestational hypertensive disorders, 2.7 (95% CI 2.4, 3.0) for chronic hypertension, and 2.5 (95% CI 2.3, 2.7) for diabetes. Fetal death rates were lowest between 38 and 41 weeks. The fetal death rate (per 1000 births) for these high-risk conditions was 61.4, 9.6, 3.5, 7.6, and 3.9, respectively. Almost two thirds of fetal deaths were attributable to the pregnancy complications examined.
High-risk conditions in pregnancy are associated with an increased risk for fetal death, particularly in the third trimester. Delivery should be considered at 38 weeks, but no later than 41 weeks, for these pregnancies.
评估特定母婴高危情况对胎儿死亡风险及死亡时间的影响。
本研究分析了1995 - 1997年美国出生/婴儿死亡数据集关联的10614679例妊娠24周及以上分娩的非畸形单胎妊娠。将低风险妊娠的胎儿死亡率与合并慢性高血压、妊娠期高血压疾病、糖尿病、小于胎龄儿及胎盘早剥的妊娠进行比较。针对每种高危情况，计算与低风险妊娠相比，不同孕周的校正相对风险及胎儿死亡的人群归因风险。
低风险妊娠的胎儿死亡率为每1000例出生中有1.6例。胎盘早剥的胎儿死亡校正相对风险为9.2（95%置信区间[CI]8.8, 9.7），小于胎龄儿为7.0（95%CI 6.8, 7.2），妊娠期高血压疾病为1.4（95%CI 1.3, 1.5），慢性高血压为2.7（95%CI 2.4, 3.0），糖尿病为2.5（95%CI 2.3, 2.7）。胎儿死亡率在38至41周时最低。这些高危情况的胎儿死亡率（每1000例出生）分别为61.4、9.6、3.5、7.6和3.9。近三分之二的胎儿死亡可归因于所研究的妊娠并发症。
妊娠高危情况与胎儿死亡风险增加相关，尤其是在孕晚期。对于这些妊娠，应考虑在38周分娩，但不迟于41周。
