Division of Neonatology, Beatrix Children's Hospital, and the Department of Health Sciences and the Division of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Obstet Gynecol. 2013 Apr;121(4):727-733. doi: 10.1097/AOG.0b013e3182860c52.
To estimate the association between pre-existing maternal and pregnancy-related factors and developmental delay in early childhood in moderately preterm-born children.
We measured development with the Ages and Stages Questionnaire at age 43-49 months in 834 moderately preterm-born (between 32 0/7 and 35 6/7 weeks of gestation) children born in 2002-2003. We obtained data on preexisting maternal, maternal pregnancy-related, fetal, and delivery-related factors. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) and attributable risks for developmental delay adjusted for sociodemographic and lifestyle variables.
Attributable risk for developmental delay for small-for-gestational-age (SGA, as a proxy for intrauterine growth restriction [IUGR]) was 14.2% (SGA 21.9%, no SGA 7.7%, P<.05, adjusted OR 2.75, CI 1.25-6.08), for preexisting maternal obesity 10.5% (obesity 18.0%, no obesity 7.5%, P<.01, adjusted OR 2.73, CI 1.35-5.52), for multiple pregnancy 4.2% (multiple 12.0%, singleton 7.8%, P<.05, adjusted OR 1.86, CI 1.02-3.42), and for male sex 9.3% (male 13.0%, female 3.8%, P<.001, adjusted OR 4.20, CI 2.09-8.46). No other preexisting or pregnancy-related maternal factors or any delivery-related factors were associated with increased risk of developmental delay.
Of all preexisting maternal and pregnancy-related factors studied, SGA, maternal prepregnancy obesity, being one of a multiple, and male sex were associated with the risk of developmental delay in early childhood after moderately preterm birth. Reinforced focus on prevention of IUGR, preconception lifestyle interventions aiming at weight reduction in fertile women, and reinforced efforts to reduce rates of multiple pregnancies in assisted reproduction may all contribute toward more favorable developmental outcomes in moderately preterm-born children.
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评估母亲和妊娠相关因素与中度早产儿儿童早期发育迟缓的关联。
我们使用年龄与阶段问卷（Ages and Stages Questionnaire）在 2002-2003 年出生的 834 名中度早产儿（胎龄 32 0/7 至 35 6/7 周之间）43-49 月龄时测量发育情况。我们收集了母亲在妊娠前、妊娠相关、胎儿和分娩相关的因素的数据。我们计算了发育迟缓的优势比（OR）和 95%置信区间（CI），并调整了社会人口统计学和生活方式变量后，计算了归因风险。
对于小于胎龄儿（SGA，代表宫内生长受限[IUGR]），发育迟缓的归因风险为 14.2%（SGA 21.9%，非 SGA 7.7%，P<.05，调整 OR 2.75，CI 1.25-6.08），母亲妊娠前肥胖为 10.5%（肥胖 18.0%，非肥胖 7.5%，P<.01，调整 OR 2.73，CI 1.35-5.52），多胎妊娠为 4.2%（多胎 12.0%，单胎 7.8%，P<.05，调整 OR 1.86，CI 1.02-3.42），男性为 9.3%（男性 13.0%，女性 3.8%，P<.001，调整 OR 4.20，CI 2.09-8.46）。其他妊娠前或妊娠相关的母亲因素或任何分娩相关因素与发育迟缓风险增加无关。
在所有研究的妊娠前和妊娠相关因素中，SGA、母亲妊娠前肥胖、多胎妊娠和男性性别与中度早产儿儿童早期发育迟缓的风险相关。加强对 IUGR 的预防、针对有生育能力的妇女的孕前生活方式干预以减少肥胖，以及加强减少辅助生殖中多胎妊娠的努力，都可能有助于改善中度早产儿儿童的发育结果。
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