高收入国家中导致死产的主要风险因素：系统评价和荟萃分析。

Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis.

机构信息

Mater Medical Research Institute, South Brisbane, QLD, Australia.

出版信息

Lancet. 2011 Apr 16;377(9774):1331-40. doi: 10.1016/S0140-6736(10)62233-7.

DOI:10.1016/S0140-6736(10)62233-7

PMID:21496916

Abstract

BACKGROUND

Stillbirth rates in high-income countries have shown little or no improvement over the past two decades. Prevention strategies that target risk factors could be important in rate reduction. This systematic review and meta-analysis was done to identify priority areas for stillbirth prevention relevant to those countries.

METHODS

Population-based studies addressing risk factors for stillbirth were identified through database searches. The factors most frequently reported were identified and selected according to whether they could potentially be reduced through lifestyle or medical intervention. The numbers attributable to modifiable risk factors were calculated from data relating to the five high-income countries with the highest numbers of stillbirths and where all the data required for analysis were available. Odds ratios were calculated for selected risk factors, from which population-attributable risk (PAR) values were calculated.

FINDINGS

Of 6963 studies initially identified, 96 population-based studies were included. Maternal overweight and obesity (body-mass index >25 kg/m(2)) was the highest ranking modifiable risk factor, with PARs of 8-18% across the five countries and contributing to around 8000 stillbirths (≥22 weeks' gestation) annually across all high-income countries. Advanced maternal age (>35 years) and maternal smoking yielded PARs of 7-11% and 4-7%, respectively, and each year contribute to more than 4200 and 2800 stillbirths, respectively, across all high-income countries. In disadvantaged populations maternal smoking could contribute to 20% of stillbirths. Primiparity contributes to around 15% of stillbirths. Of the pregnancy disorders, small size for gestational age and abruption are the highest PARs (23% and 15%, respectively), which highlights the notable role of placental pathology in stillbirth. Pre-existing diabetes and hypertension remain important contributors to stillbirth in such countries.

INTERPRETATION

The raising of awareness and implementation of effective interventions for modifiable risk factors, such as overweight, obesity, maternal age, and smoking, are priorities for stillbirth prevention in high-income countries.

FUNDING

The Stillbirth Foundation Australia, the Department of Health and Ageing, Canberra, Australia, and the Mater Foundation, Brisbane, Australia.

摘要

背景

在过去的二十年中，高收入国家的死产率几乎没有或没有改善。针对风险因素的预防策略可能对降低发病率很重要。本系统评价和荟萃分析旨在确定与这些国家相关的死产预防的重点领域。

方法

通过数据库搜索确定了针对死产风险因素的基于人群的研究。根据这些因素是否可以通过生活方式或医疗干预来降低，确定并选择最常报告的因素。从与死产数量最高的五个高收入国家相关的数据中计算出可改变风险因素的归因数量，并且这些国家都有进行分析所需的所有数据。从选定的风险因素中计算出比值比，从中计算出人群归因风险 (PAR) 值。

结果

在最初确定的 6963 项研究中，有 96 项基于人群的研究被纳入。母体超重和肥胖（体重指数 >25 kg/m²）是排名最高的可改变风险因素，在五个国家中的 PAR 值为 8-18%，每年在所有高收入国家导致约 8000 例死产（≥22 周妊娠）。高龄产妇（>35 岁）和孕妇吸烟的 PAR 值分别为 7-11%和 4-7%，每年在所有高收入国家分别导致超过 4200 例和 2800 例死产。在弱势群体中，孕妇吸烟可能导致 20%的死产。初产妇占死产的 15%左右。在妊娠疾病中，胎儿大小与妊娠周数不匹配和胎盘早剥的 PAR 值最高（分别为 23%和 15%），这突出了胎盘病理在死产中的显著作用。在这些国家，既往糖尿病和高血压仍然是死产的重要原因。