Ehrenstein Vera, Pedersen Lars, Holsteen Vibeke, Larsen Helle, Rothman Kenneth J, Sørensen Henrik T
Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
Pediatrics. 2007 Mar;119(3):e554-61. doi: 10.1542/peds.2006-1308.
Postterm delivery is a risk factor for perinatal complications, some of which increase risk for neurologic morbidity. We aimed to examine the association between postterm delivery and risk for epilepsy in childhood.
We conducted a cohort study of singleton children who were born in 3 Danish counties from 1980 to 2001. Birth registry data were linked with hospital records to identify cases of epilepsy in the first 12 years of life. We included children who were born at > or = 39 gestational weeks and computed crude, age-specific, and birth weight standardized incidence rates of epilepsy. We estimated adjusted incidence rate ratios according to mode of delivery by Poisson regression.
Among the 277,435 nonpreterm births, 32,557 were at > or = 42 weeks, including 3396 at > or = 43 weeks. Nearly one fourth of the 2805 epilepsy cases occurred in the first year of life. In that period, birth weight standardized incidence rate ratios for epilepsy were 1.3 for birth at 42 weeks and 2.0 for birth at > or = 43 weeks, compared with birth at 39 to 41 weeks. Among children who were delivered by cesarean section, incidence rate ratios adjusted for birth weight, presentation, malformations, and county were 1.4 for birth at 42 completed weeks and 4.9 for birth at > or = 43 weeks, compared with term vaginal births. There was a similar tendency among children who were delivered with the assistance of instruments. We found no evidence for the association between postterm delivery and risk for epilepsy beyond the first year of life.
Prolonged gestation is a risk factor for early epilepsy; the added increase in risk for instrument-assisted and cesarean deliveries could be attributable to factors that are related to both birth complications and epilepsy.
过期产是围产期并发症的一个危险因素，其中一些并发症会增加神经疾病的发病风险。我们旨在研究过期产与儿童期癫痫风险之间的关联。
我们对1980年至2001年在丹麦3个县出生的单胎儿童进行了一项队列研究。将出生登记数据与医院记录相链接，以确定出生后前12年的癫痫病例。我们纳入了孕周≥39周出生的儿童，并计算了癫痫的粗发病率、年龄特异性发病率和出生体重标准化发病率。通过泊松回归根据分娩方式估计调整后的发病率比值。
在277,435例非早产出生中，32,557例孕周≥42周，其中3396例孕周≥43周。2805例癫痫病例中近四分之一发生在出生后第一年。在该时期，与39至41周出生的儿童相比，42周出生时癫痫的出生体重标准化发病率比值为1.3，≥43周出生时为2.0。在剖宫产分娩的儿童中，与足月阴道分娩相比，根据出生体重、胎位、畸形和所在县调整后的发病率比值，在42足周出生时为1.4，≥43周出生时为4.9。在器械助产分娩的儿童中也有类似趋势。我们没有发现证据表明过期产与出生后第一年以后的癫痫风险之间存在关联。
孕周延长是早期癫痫的一个危险因素；器械助产和剖宫产分娩风险的额外增加可能归因于与分娩并发症和癫痫均相关的因素。
