Chen Aimin, Feresu Shingairai A, Barsoom Michael J
From the Department of Preventive Medicine and Public Health, Creighton University School of Medicine; Department of Epidemiology, College of Public Health, University of Nebraska Medical Center; and Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, Nebraska.
Obstet Gynecol. 2009 Sep;114(3):516-522. doi: 10.1097/AOG.0b013e3181b473fc.
To investigate the heterogeneity of preterm labor, preterm premature rupture of membranes (PROM), and indicated preterm birth in overall and gestational-age-specific neonatal death risk.
We used 2001 U.S. linked birth/infant death (birth cohort) data sets for this analysis. We categorized three preterm birth subtypes according to reported preterm PROM, induction of labor, cesarean delivery, and pregnancy and labor complications. We used Cox proportional hazard models to calculate covariates adjusted hazard ratios (HRs) for neonatal death (0-27 days of life) among preterm neonates born at 24-27, 28-31, 32-33, and 34-36 weeks of gestation, with preterm labor being the referent.
There were 3,763,306 singleton live births at 24-44 weeks of gestation in the data set. Preterm PROM, indicated preterm birth, and preterm labor had neonatal death risk of 2.7%, 1.8%, and 1.1%, respectively. Compared with preterm labor, preterm PROM had shorter gestational age and lower birth weight, so did indicated preterm birth but to a lesser extent. Preterm PROM and indicated preterm birth after 28 weeks of gestation were associated with higher neonatal death risk than preterm labor. At 34-36 weeks of gestation, the HR of preterm PROM was 1.53 (95% confidence interval 1.20-1.95), and the HR of indicated preterm birth was 2.06 (95% confidence interval 1.83-2.33). The increased risk from preterm PROM and indicated preterm birth was not limited to early neonatal death in the first 7 days.
Preterm PROM and indicated preterm birth had higher risk of neonatal death than preterm labor, indicating heterogeneity in gestational age distribution and gestational-age-specific neonatal death risk.
II.
探讨早产、胎膜早破（PROM）及医源性早产在总体及特定孕周新生儿死亡风险中的异质性。
我们使用2001年美国出生/婴儿死亡关联数据集（出生队列）进行此分析。我们根据报告的早产PROM、引产、剖宫产以及妊娠和分娩并发症对三种早产亚型进行分类。我们使用Cox比例风险模型计算在妊娠24 - 27周、28 - 31周、32 - 33周和34 - 36周出生的早产新生儿中，调整协变量后的新生儿死亡（出生后0 - 27天）风险比（HRs），以早产为参照。
数据集中有3,763,306例妊娠24 - 44周的单胎活产。早产PROM、医源性早产和早产的新生儿死亡风险分别为2.7%、1.8%和1.1%。与早产相比，早产PROM的孕周更短，出生体重更低，医源性早产也是如此，但程度较轻。妊娠28周后，早产PROM和医源性早产与更高的新生儿死亡风险相关。在妊娠34 - 36周时，早产PROM的HR为1.53（95%置信区间1.20 - 1.95），医源性早产的HR为2.06（95%置信区间1.83 - 2.33）。早产PROM和医源性早产增加的风险不仅限于出生后前7天的早期新生儿死亡。
早产PROM和医源性早产的新生儿死亡风险高于早产，表明在孕周分布和特定孕周新生儿死亡风险方面存在异质性。
II级。
