Haraldsdottir Sigridur, Gudmundsson Sigurdur, Bjarnadottir Ragnheidur I, Lund Sigrun H, Valdimarsdottir Unnur A
Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Division of Health Information and Research, Directorate of Health, Reykjavik, Iceland.
Acta Obstet Gynecol Scand. 2015 Feb;94(2):156-64. doi: 10.1111/aogs.12534. Epub 2014 Nov 28.
To describe pregnancy complications, mode of delivery and neonatal outcomes by mother's residence.
Register-based cohort study.
Geographical regions of Iceland.
Live singleton births from 1 January 2000 to 31 December 2009 (n = 40 982) and stillbirths ≥22 weeks or weighing ≥500 g (n = 145).
Logistic regression was used to explore differences in outcomes by area of residence while controlling for potential confounders. Maternal residence was classified according to distance from Capital Area and availability of local health services.
Preterm birth, low birthweight, perinatal death, gestational diabetes and hypertension.
Of the 40 982 infants of the study population 26 255 (64.1%) were born to mothers residing in the Capital Area and 14 727 (35.9%) to mothers living outside the Capital Area. Infants outside the Capital Area were more likely to have been delivered by cesarean section (adjusted odds ratio 1.28; 95% CI 1.21-1.36). A lower prevalence of gestational diabetes (adjusted odds ratio 0.68; 95% CI 0.59-0.78), hypertension (adjusted odds ratio 0.82; 95% CI 0.71-0.94) as well as congenital malformations (adjusted odds ratio 0.55; 95% CI 0.48-0.63) was observed outside the Capital Area. We observed neither differences in mean birthweight, gestation length nor rate of preterm birth or low birthweight across Capital Area and non-Capital Area. The odds of perinatal deaths were significantly higher (adjusted odds ratio 1.87; 95% CI 1.18-2.95) outside the Capital Area in the second half of the study period.
Lower prevalence of gestational diabetes and hypertension outside the Capital Area may be an indication of underreporting and/or lower diagnostic activity.
按母亲居住地描述妊娠并发症、分娩方式及新生儿结局。
基于登记的队列研究。
冰岛的地理区域。
2000年1月1日至2009年12月31日的单胎活产（n = 40982）以及孕周≥22周或体重≥500g的死产（n = 145）。
采用逻辑回归分析探讨居住地不同对结局的影响，并控制潜在混杂因素。根据距首都地区的距离和当地医疗服务的可及性对母亲居住地进行分类。
早产、低出生体重、围产期死亡、妊娠期糖尿病和高血压。
研究人群中的40982名婴儿中，26255名（64.1%）的母亲居住在首都地区，14727名（35.9%）的母亲居住在首都地区以外。首都地区以外的婴儿剖宫产分娩的可能性更高（调整优势比1.28；95%可信区间1.21 - 1.36）。首都地区以外妊娠期糖尿病（调整优势比0.68；95%可信区间0.59 - 0.78）、高血压（调整优势比0.82；95%可信区间0.71 - 0.94）以及先天性畸形（调整优势比0.55；95%可信区间0.48 - 0.63）的患病率较低。我们未观察到首都地区和非首都地区在平均出生体重、孕周、早产率或低出生体重率方面存在差异。在研究期后半段，首都地区以外围产期死亡的几率显著更高（调整优势比1.87；95%可信区间1.18 - 2.95）。
首都地区以外妊娠期糖尿病和高血压患病率较低可能表明报告不足和/或诊断活动较少。
