Department of Public Health and Public Policy, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Pediatr. 2013 Dec;163(6):1578-1584.e4. doi: 10.1016/j.jpeds.2013.07.004. Epub 2013 Aug 20.
To examine associations between the duration of gestation and health and development outcomes at 2.5 years and 5.5 years using a Japanese population-based longitudinal survey (n = 47 015).
Hospitalization was used as an indicator of physical health, and responses to questions about age-appropriate behaviors were used as an indicator of behavioral development. We conducted logistic regression analyses controlling for a set of neonatal and family factors. We also estimated population-attributable fractions.
We observed a steady increase toward shorter duration of gestation in the risk of hospitalizations at age 2.5 years and 5.5 years and developmental delays at 2.5 years (Plinear trend < .001 for all outcomes). We found associations only between extremely preterm birth and delayed behavioral development at age 5.5 years.
There is a linear relationship between shorter duration of gestation and increased risk of later health and developmental problems. In line with Rose's "population paradox," the population-attributable risks for these problems are greater for moderately preterm infants compared with extremely preterm infants.
利用一项日本基于人群的纵向调查（n=47015），研究妊娠持续时间与 2.5 岁和 5.5 岁时健康和发育结局之间的关联。
以住院治疗作为身体健康的指标，以回答与年龄相适应的行为问题的方式作为行为发育的指标。我们进行了逻辑回归分析，控制了一系列新生儿和家庭因素。我们还估计了人群归因分数。
我们观察到，在 2.5 岁和 5.5 岁时，住院治疗的风险和发育迟缓的风险（所有结局的线性趋势 P<0.001）随妊娠持续时间的缩短而呈稳步上升趋势。我们仅发现极早产与 5.5 岁时行为发育延迟之间存在关联。
妊娠持续时间较短与后期健康和发育问题的风险增加呈线性关系。与 Rose 的“人群悖论”一致，这些问题的人群归因风险对于中度早产儿而言，大于极早产儿。
