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自发性晚期早产和早期足月产的生物学决定因素:一项回顾性队列研究。

Biological determinants of spontaneous late preterm and early term birth: a retrospective cohort study.

机构信息

Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada.

出版信息

BJOG. 2015 Mar;122(4):491-9. doi: 10.1111/1471-0528.13191. Epub 2014 Nov 21.

Abstract

OBJECTIVE

Our aim was to examine the association between biological determinants of preterm birth (infection and inflammation, placental ischaemia and other hypoxia, diabetes mellitus, other) and spontaneous late preterm (34-36 weeks) and early term (37-38 weeks) birth.

DESIGN

Retrospective cohort study.

SETTING

City of London and Middlesex County, Canada.

SAMPLE

Singleton live births, delivered at 34-41 weeks to London-Middlesex mothers following spontaneous labour.

METHODS

Data were obtained from a city-wide perinatal database on births between 2002 and 2011 (n = 17,678). Multivariable analyses used multinomial logistic regression.

MAIN OUTCOME MEASURE

The outcome of interest was the occurrence of late preterm (34-36 weeks) and early term (37-38 weeks) birth, compared with full term birth (39-41 weeks).

RESULTS

After controlling for covariates, there were associations between infection and inflammation and late preterm birth (aOR = 2.07, 95% CI 1.65, 2.60); between placental ischaemia and other hypoxia and late preterm (aOR = 2.21, 95% CI 1.88, 2.61) and early term (aOR = 1.25, 95% CI 1.13, 1.39) birth; between diabetes mellitus and late preterm (aOR = 3.89, 95% CI 2.90, 5.21) and early term (aOR = 2.66, 95% CI 2.19, 3.23) birth; and between other biological determinants (polyhydramnios, oligohydramnios) and late preterm (aOR = 2.81, 95% CI 1.70, 4.64) and early term (aOR = 1.89, 95% CI 1.32, 2.70) birth.

CONCLUSIONS

Our findings show that delivery following spontaneous labour even close to full term may be a result of pathological processes. Because these biological determinants of preterm birth contribute to an adverse intrauterine environment, they have important implications for fetal and neonatal health.

摘要

目的

本研究旨在探讨早产的生物学决定因素(感染和炎症、胎盘缺血和其他缺氧、糖尿病等)与自发性晚期早产(34-36 周)和早期足月(37-38 周)分娩之间的关联。

设计

回顾性队列研究。

地点

加拿大伦敦市和米德尔塞克斯县。

样本

2002 年至 2011 年间,伦敦-米德尔塞克斯产妇自发性分娩的 34-41 周单胎活产儿。

方法

数据来自全市围产期数据库,共纳入 17678 例活产儿。多变量分析采用多项逻辑回归。

主要结局指标

感兴趣的结局是晚期早产(34-36 周)和早期足月(37-38 周)分娩与足月(39-41 周)分娩相比的发生情况。

结果

在校正协变量后,感染和炎症与晚期早产(aOR=2.07,95%CI 1.65-2.60)、胎盘缺血和其他缺氧与晚期早产(aOR=2.21,95%CI 1.88-2.61)和早期足月(aOR=1.25,95%CI 1.13-1.39)、糖尿病与晚期早产(aOR=3.89,95%CI 2.90-5.21)和早期足月(aOR=2.66,95%CI 2.19-3.23)分娩之间存在关联;其他生物学决定因素(羊水过多、羊水过少)与晚期早产(aOR=2.81,95%CI 1.70-4.64)和早期足月(aOR=1.89,95%CI 1.32-2.70)分娩之间也存在关联。

结论

本研究结果表明,即使接近足月的自发性分娩也可能是病理过程的结果。由于早产的这些生物学决定因素导致不良的宫内环境,因此对胎儿和新生儿健康具有重要意义。

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