Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, Center for Research on Reproduction and Women's Health, University of Pennsylvania, Philadelphia, PA 19104, USA.
Matern Child Health J. 2012 Apr;16(3):564-8. doi: 10.1007/s10995-011-0783-z.
Despite the introduction of 17-alpha-hydroxyprogesterone caproate (17P), the national preterm birth (PTB) rate remains unchanged. Our objectives were to determine whether the overall rate of PTB has decreased and whether there has been a shift in the trends of prematurity at our institution since the initiation of 17P use. We performed a cross sectional study of the PTB rate and gestational age distribution at delivery (GA-del) at our institution over two, 2-year time periods: TP1 (pre 17P, 1 Jan 2004-31 Dec 2005) and TP2 (post 17P, 1 Jan 2008-31 Dec 2009). Statistical analyses included χ(2) tests for categorical data, t-tests for continuous data, and multivariable logistic regression to control for confounders. Overall (n = 15,421), there was no difference in the rate of PTB from TP1 to TP2 (16.65 vs 16.95%, p = 0.62). Among those with a history of prior PTB (n = 2,141), the mean preterm GA-del was 10 days later in TP2 than in TP1 (33.13 vs 31.64 weeks, p < 0.01) and significantly more preterm infants in TP2 delivered between 34-36 6/7 weeks than in TP1 (65.00 vs 45.63%, p < 0.01). The odds of a preterm infant delivering in the late preterm period was 2.3-fold higher in TP2 than TP1 (95% CI 1.49-3.54) after controlling for confounders. The significant shift in GA-del towards the late preterm period in TP2 may be due to the introduction of 17P use at our institution. Additional studies are needed to determine whether these trends persist on a nationwide level.
尽管已经引入了 17-α-羟孕酮己酸酯（17P），但全国性的早产（PTB）率仍保持不变。我们的目标是确定自使用 17P 以来，我们机构的 PTB 总体发生率是否降低，以及早产趋势是否发生变化。我们对我们机构在两个为期 2 年的时间内的 PTB 发生率和分娩时的孕龄分布（GA-del）进行了横断面研究：TP1（17P 前，2004 年 1 月 1 日至 2005 年 12 月 31 日）和 TP2（17P 后，2008 年 1 月 1 日至 2009 年 12 月 31 日）。统计分析包括卡方检验用于分类数据，t 检验用于连续数据，以及多变量逻辑回归来控制混杂因素。总体上（n=15421），从 TP1 到 TP2，PTB 的发生率没有差异（16.65%对 16.95%，p=0.62）。在有早产史的患者中（n=2141），TP2 的平均早产 GA-del 比 TP1 晚 10 天（33.13 对 31.64 周，p<0.01），并且在 TP2 中，更多的早产婴儿在 34-36 6/7 周之间分娩，而在 TP1 中，这一比例为 45.63%（65.00%对 45.63%，p<0.01）。在校正混杂因素后，TP2 中早产儿在晚期早产期间分娩的几率是 TP1 的 2.3 倍（95%CI 1.49-3.54）。TP2 中 GA-del 向晚期早产的显著转移可能是由于我们机构引入了 17P 的使用。需要进一步的研究来确定这些趋势是否在全国范围内持续存在。
