Basso Olga, Rasmussen Svein, Weinberg Clarice R, Wilcox Allen J, Irgens Lorentz M, Skjaerven Rolv
Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA.
JAMA. 2006 Sep 20;296(11):1357-62. doi: 10.1001/jama.296.11.1357.
Management of preeclampsia often culminates in induced delivery of a very preterm infant. While early termination protects the fetus from an intrauterine death, the newborn then faces increased risks associated with preterm delivery. This practice has increased in recent decades, but its net effect on fetal and infant survival has not been assessed.
To assess the effect on fetal and infant survival of increased rates of early delivery of preeclamptic pregnancies.
DESIGN, SETTING, AND PARTICIPANTS: Population-based observational longitudinal study using registry data from 804 448 singleton first-born infants with Norwegian-born mothers and registered in the Medical Birth Registry of Norway between 1967 and 2003.
Odds ratio (OR) of fetal and early childhood death in relation to preeclampsia.
Among preeclamptic pregnancies, inductions before 37 weeks increased from 8% in 1967-1978 to nearly 20% in 1991-2003. During this period, the adjusted OR for stillbirth decreased from 4.2 (95% confidence interval [CI], 3.8-4.7) to 1.3 (95% CI, 1.1-1.7) for preeclamptic compared with nonpreeclamptic pregnancies. During the same period, the OR for neonatal death after preeclamptic pregnancy remained relatively stable (1.7 in 1967-1978 vs 2.0 in 1991-2003). Later infant and childhood mortality also showed little change.
Fetal survival in preeclamptic pregnancies has vastly improved over the past 35 years in Norway, presumably because of more aggressive clinical management. However, the relative risk of neonatal death following a preeclamptic pregnancy has not changed over time.
子痫前期的治疗往往最终导致极早产婴儿的引产。虽然提前终止妊娠可保护胎儿免于宫内死亡，但新生儿随后面临与早产相关的更多风险。近几十年来这种做法有所增加，但其对胎儿和婴儿生存的净影响尚未得到评估。
评估子痫前期妊娠提前分娩率增加对胎儿和婴儿生存的影响。
设计、地点和参与者：基于人群的观察性纵向研究，使用了来自挪威医疗出生登记处1967年至2003年间登记的804448名单胎头胎婴儿及其挪威出生母亲的登记数据。
与子痫前期相关的胎儿和幼儿死亡的比值比（OR）。
在子痫前期妊娠中，37周前的引产率从1967 - 1978年的8%增加到1991 - 2003年的近20%。在此期间，子痫前期妊娠与非子痫前期妊娠相比，死产的校正OR从4.2（95%置信区间[CI]，3.8 - 4.7）降至1.3（95%CI，1.1 - 1.7）。在同一时期，子痫前期妊娠后的新生儿死亡OR保持相对稳定（1967 - 1978年为1.7，1991 - 2003年为2.0）。后期婴儿和儿童死亡率也变化不大。
在挪威，过去35年里子痫前期妊娠中的胎儿存活率有了极大提高，大概是因为临床管理更加积极。然而，子痫前期妊娠后新生儿死亡的相对风险并未随时间改变。
