与医学指征的晚期早产儿和足月产相关的母胎胎盘情况：一项回顾性研究。

Maternal, fetal, and placental conditions associated with medically indicated late preterm and early term delivery: a retrospective study.

机构信息

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

Children's Health Research Institute, London, ON, Canada.

出版信息

BJOG. 2016 Apr;123(5):763-70. doi: 10.1111/1471-0528.13428. Epub 2015 May 15.

DOI:10.1111/1471-0528.13428

PMID:25976430

Abstract

OBJECTIVE

Our objectives were: (1) to examine the association between maternal, fetal, and placental phenotypes of preterm delivery and medically indicated early delivery of singletons during the late preterm and early term periods; and (2) to identify the specific maternal, fetal, and placental conditions associated with these early deliveries.

DESIGN

Retrospective study.

SETTING

City of London and Middlesex County, Ontario, Canada.

SAMPLE

Singleton live deliveries, at 34-41 weeks of gestation to women in London and Middlesex.

METHODS

We obtained data from a city-wide perinatal database (2002-2011; n = 25 699). We used multinomial logistic regression for multivariable analyses.

MAIN OUTCOME MEASURE

The outcome was the occurrence of medically indicated late preterm (34-36 weeks of gestation) and early term (37-38 weeks of gestation) delivery, versus delivery at full term (39-41 weeks of gestation).

RESULTS

After controlling for confounding factors, all phenotypes were associated with increased odds of medically indicated late preterm and early term delivery. Within the maternal phenotype, chronic maternal medical conditions were associated with increased odds of medically indicated early term delivery (e.g. for gastrointestinal disease, adjusted odds ratio, aOR 1.72, 95% CI 1.47-2.00; for anaemia, aOR 1.40, 95% CI 1.20-1.63), but not late preterm delivery.

CONCLUSIONS

The aetiology of medically indicated early delivery close to full term is heterogeneous. Patterns of associations suggest slightly different conditions underlying the late preterm and early term phenotypes, with chronic maternal medical conditions being associated with early term delivery but not with late preterm delivery. These results have implications for the prevention of early delivery as well as the identification of high-risk groups among those born early.

TWEETABLE ABSTRACT

The aetiology of medically indicated late preterm and early term delivery is heterogeneous.

摘要

目的

我们的目的是：（1）研究早产的母体、胎儿和胎盘表型与晚期早产和早期足月期间因医学指征行单胎早期分娩的关系；（2）确定与这些早期分娩相关的具体母体、胎儿和胎盘情况。

设计

回顾性研究。

地点

加拿大安大略省伦敦市和米德尔塞克斯县。

样本

伦敦和米德尔塞克斯的孕妇在 34-41 孕周时分娩的单胎活产儿。

方法

我们从全市围产期数据库（2002-2011 年；n=25699）中获取数据。我们使用多变量逻辑回归进行多变量分析。

主要观察指标

结局为因医学指征行晚期早产（34-36 孕周）和早期足月（37-38 孕周）分娩，与足月（39-41 孕周）分娩相比。

结果

在控制混杂因素后，所有表型均与因医学指征行晚期早产和早期足月分娩的几率增加相关。在母体表型中，慢性母体疾病与因医学指征行早期足月分娩的几率增加相关（例如，胃肠道疾病的调整比值比[aOR]为 1.72，95%可信区间[CI]为 1.47-2.00；贫血的 aOR 为 1.40，95%CI 为 1.20-1.63），但与晚期早产无关。