Smith Gordon C S, Crossley Jennifer A, Aitken David A, Pell Jill P, Cameron Alan D, Connor J Michael, Dobbie Richard
Department of Obstetrics and Gynaecology, Cambridge University and Rosie Hospital, Cambridge, England.
JAMA. 2004 Nov 10;292(18):2249-54. doi: 10.1001/jama.292.18.2249.
Preterm birth and low birth weight are determined, at least in part, during the first trimester of pregnancy. However, it is unknown whether the risk of stillbirth is also determined during the first trimester.
To determine whether the risk of antepartum stillbirth varies in relation to circulating markers of placental function measured during the first trimester of pregnancy.
DESIGN, SETTING, AND PARTICIPANTS: Multicenter, prospective cohort study (conducted in Scotland from 1998 through 2000) of 7934 women who had singleton births at or after 24 weeks' gestation, who had blood taken during the first 10 weeks after conception, and who were entered into national registries of births and perinatal deaths.
Antepartum stillbirths and stillbirths due to specific causes.
There were 8 stillbirths among the 400 women with levels of pregnancy-associated plasma protein A (PAPP-A) in the lowest fifth percentile compared with 17 among the remaining 7534 women (incidence rate per 10,000 women per week of gestation: 13.4 vs 1.4, respectively; hazard ratio [HR], 9.2 [95% confidence interval [CI], 4.0-21.4]; P<.001). When analyzed by cause of stillbirth, low level of PAPP-A was strongly associated with stillbirth due to placental dysfunction, defined as abruption or unexplained stillbirth associated with growth restriction (incidence rate: 11.7 vs 0.3, respectively; HR, 46.0 [95% CI, 11.9-178.0]; P<.001), but was not associated with other causes of stillbirth (incidence rate: 1.7 vs 1.1, respectively; HR, 1.4 [95% CI, 0.2-10.6]; P = .75). There was no relationship between having a low level of PAPP-A and maternal age, ethnicity, parity, height, body mass index, race, or marital status. Adjustment for maternal factors did not attenuate the strength of associations observed. There was no association between maternal circulating levels of the free beta subunit of human chorionic gonadotropin and stillbirth risk.
The risk of stillbirth in late pregnancy may be determined by placental function in the first 10 weeks after conception.
早产和低出生体重至少部分是在妊娠早期决定的。然而，死产风险是否也在妊娠早期决定尚不清楚。
确定妊娠早期测量的胎盘功能循环标志物与产前死产风险之间是否存在差异。
设计、地点和参与者：对7934名单胎妊娠24周及以后分娩、在受孕后前10周采血并纳入国家出生和围产期死亡登记处的妇女进行的多中心前瞻性队列研究（1998年至2000年在苏格兰开展）。
产前死产和特定原因导致的死产。
妊娠相关血浆蛋白A（PAPP-A）水平处于最低五分位数的400名妇女中有8例死产，其余7534名妇女中有17例死产（每10000名妇女每孕周的发病率分别为13.4和1.4；风险比[HR]，9.2[95%置信区间[CI]，4.0-21.4]；P<.001）。按死产原因分析时，PAPP-A水平低与胎盘功能障碍导致的死产密切相关，胎盘功能障碍定义为胎盘早剥或与生长受限相关的不明原因死产（发病率分别为11.7和0.3；HR，46.0[95%CI，11.9-178.0]；P<.001），但与其他死产原因无关（发病率分别为1.7和1.1；HR，1.4[95%CI，0.2-10.6]；P = 0.75）。PAPP-A水平低与产妇年龄、种族、产次、身高、体重指数、种族或婚姻状况之间没有关系。对产妇因素进行调整并未减弱观察到的关联强度。母体循环中绒毛膜促性腺激素游离β亚基水平与死产风险之间没有关联。
妊娠晚期的死产风险可能由受孕后前10周的胎盘功能决定。
