Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia; the Department of Obstetrics and Gynaecology, Kuopio University Hospital, and the School of Medicine, University of Eastern Finland, Kuopio, and the National Institute for Health and Welfare, Helsinki, Finland; and the Nordic School of Public Health, Gothenburg, Sweden.
Obstet Gynecol. 2014 Aug;124(2 Pt 1):285-291. doi: 10.1097/AOG.0000000000000368.
To evaluate whether there is an association between placenta previa and delivery of a small-for-gestational-age (SGA) newborn and to quantify the contribution of individual risk factors for SGA that are associated with placenta previa stratified by maternal parity.
A cross-sectional study using the Finnish Medical Birth Register during 2000-2010. All singleton births (N=596,562) were included; major congenital anomalies were excluded. An association between SGA (less than 2 standard deviations below the mean) and placenta previa was modeled by parity-specific unadjusted and adjusted statistical models.
Placenta previa complicated 625 of 249,476 singleton births among nulliparous women (2.50/1,000) and 915 of 347,086 singleton births among multiparous women (2.64/1,000). Among nulliparous women, the most common risk factor for placenta previa was in vitro fertilization; placenta previa was not associated with an increased prevalence of SGA controlling for maternal age, smoking, in vitro fertilization, socioeconomic status, and preeclampsia (adjusted odds ratio [OR] 0.81, 95% confidence interval [CI] 0.57-1.17). Among multiparous women, placenta previa was associated with a twofold increased risk of SGA controlling for maternal age, parity, prior preterm birth, prior caesarean delivery, prior SGA newborn, prior preeclampsia, smoking, in vitro fertilization, socioeconomic status, and preeclampsia (adjusted OR 2.08, 95% CI 1.50-2.89). Furthermore, only one-fourth of the association between SGA and placenta previa could be explained by controlling for risk factors clustering with placenta previa among multiparous women.
Placenta previa is associated with impaired fetal growth in multiparous but not nulliparous women.
II.
评估前置胎盘与胎儿生长受限（SGA）新生儿分娩之间是否存在关联，并定量分析与前置胎盘相关的个体 SGA 风险因素在按产妇产次分层时对前置胎盘的贡献。
这是一项 2000-2010 年期间使用芬兰医疗出生登记处进行的横断面研究。所有单胎分娩（N=596562）均包括在内；排除了主要先天畸形。通过特定于产次的未调整和调整后的统计模型，对 SGA（低于平均值 2 个标准差以下）与前置胎盘之间的关联进行建模。
在初产妇中，249476 例单胎分娩中出现 625 例（2.50/1000）前置胎盘，347086 例单胎分娩中出现 915 例（2.64/1000）前置胎盘。在初产妇中，导致前置胎盘的最常见风险因素是体外受精；控制母亲年龄、吸烟、体外受精、社会经济状况和子痫前期后，前置胎盘与 SGA 的患病率增加无关（调整后的比值比[OR]0.81，95%置信区间[CI]0.57-1.17）。在经产妇中，控制母亲年龄、产次、早产史、剖宫产史、SGA 新生儿史、子痫前期史、吸烟、体外受精、社会经济状况和子痫前期后，前置胎盘与 SGA 风险增加两倍相关（调整后的 OR 2.08，95%CI1.50-2.89）。此外，在经产妇中，只有四分之一的 SGA 与前置胎盘之间的关联可以通过控制与前置胎盘相关的风险因素来解释。
前置胎盘与多产妇而非初产妇的胎儿生长受损相关。
II。
