Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Eur J Obstet Gynecol Reprod Biol. 2011 Jan;154(1):40-4. doi: 10.1016/j.ejogrb.2010.08.011. Epub 2010 Sep 24.
To assess the independent role of prenatal care in preventing recurrent preterm delivery (<37 weeks gestation) and in reducing adverse pregnancy outcomes in recurrent preterm delivery.
A population-based retrospective cohort study. Participants were 1470 Bedouin women in Southern Israel who at their first delivery (parity 1) gave birth preterm (<37 weeks) and had a consecutive birth (parity 2) at Soroka University Medical Center, the only birth hospital in the area. Multiple gestations were excluded.
The incidence of recurrent preterm delivery was 24.6% (362/1470) and it was not associated with having had prenatal care in the second pregnancy. In a multivariable logistic analysis, young maternal age, pregnancy complications and fetal abnormalities in the second pregnancy, as well as previous miscarriages, short inter-pregnancy interval, and length of gestation in the first pregnancy were significantly associated with recurrence. The incidence of adverse pregnancy outcomes (perinatal mortality, small for gestational age, gestational age <34 weeks, Apgar ≤ 7) in recurrent preterm delivery was 44.8% (162/362). Lack of prenatal care was significantly associated with adverse pregnancy outcomes (odds ratio: 4.03; 95% confidence interval: 2.04-7.97) in a multivariable logistic analysis controlling for all variables significantly associated with adverse pregnancy outcomes at the univariate analysis.
Prenatal care may reduce the risk of adverse pregnancy outcomes in recurrent preterm delivery, even if recurrence cannot be prevented. It is therefore important that quality prenatal care is accessible to women who had a preterm delivery in the past.
评估产前保健在预防复发性早产（<37 周妊娠）和减少复发性早产不良妊娠结局中的独立作用。
基于人群的回顾性队列研究。研究对象为以色列南部的 1470 名贝都因妇女，她们在首次分娩（产次 1）时早产（<37 周），并在索罗卡大学医学中心（该地区唯一的分娩医院）连续分娩（产次 2）。排除多胎妊娠。
复发性早产的发生率为 24.6%（362/1470），与第二胎产前保健无关。在多变量逻辑分析中，母亲年龄较小、第二胎妊娠并发症和胎儿异常、既往流产史、妊娠间隔较短、第一胎妊娠时间较短与复发显著相关。复发性早产不良妊娠结局（围产儿死亡率、小于胎龄儿、妊娠 34 周以下、Apgar≤7）的发生率为 44.8%（162/362）。在多变量逻辑分析中，控制所有在单变量分析中与不良妊娠结局显著相关的变量后，缺乏产前保健与不良妊娠结局显著相关（比值比：4.03；95%置信区间：2.04-7.97）。
即使不能预防复发性早产，产前保健也可能降低其不良妊娠结局的风险。因此，为过去有早产史的妇女提供优质的产前保健至关重要。
