Gimenez Lucas G, Krupitzki Hugo B, Momany Allison M, Gili Juan A, Poletta Fernando A, Campaña Hebe, Cosentino Viviana R, Saleme César, Pawluk Mariela, Murray Jeffrey C, Castilla Eduardo E, Gadow Enrique C, Lopez-Camelo Jorge S
a Dirección De Investigación, CEMIC (Centro De Educación Médica E Investigaciones Clínicas) , Galván 4102 , Buenos Aires , Argentina .
b ECLAMC (Estudio Colaborativo Latinoamericano De Malformaciones Congénitas) at CEMIC , Buenos Aires , Argentina .
J Matern Fetal Neonatal Med. 2016 Oct;29(19):3153-61. doi: 10.3109/14767058.2015.1118035. Epub 2015 Dec 23.
This study was designed to characterize and compare the maternal and newborn epidemiological characteristics through analysis of environmental factors, sociodemographic characteristics and clinical characteristics between the different clinical subtypes of preterm birth (PTB): Idiopathic (PTB-I), premature rupture of the membranes (PTB-PPROM) and medically indicated (PTB-M). The two subtypes PTB-I and PTB-PPROM grouped are called spontaneous preterm births (PTB-S).
A retrospective, observational study was conducted in 1.291 preterm nonmalformed singleton live-born children to nulliparous and multiparous mother's in Tucumán-Argentina between 2005 and 2010. Over 50 maternal variables and 10 newborn variables were compared between the different clinical subtypes. The comparisons were done to identify heterogeneity between subtypes of preterm birth: (PTB-S) versus (PTB-M), and within spontaneous subtype: (PTB-I) versus (PTB-PPROM). In the same way, two conditional logistic multivariate regressions were used to compare the odds ratio (OR) between PTB-S and PTB-M, as well as PTB-I and PTB-PPROM. We matched for maternal age when comparing maternal variables and gestational age when comparing infant variables.
The PTB-I subtype was characterized by younger mothers of lower socio-economic status, PTB-PPROM was characterized by environmental factors resulting from inflammatory processes, and PTB-M was characterized by increased maternal or fetal risk pregnancies.
The main risk factor for PTB-I and PTB-M was having had a prior preterm delivery; however, previous spontaneous abortion was not a risk factor, suggesting a reproductive selection mechanism.
本研究旨在通过分析早产（PTB）不同临床亚型（特发性早产（PTB-I）、胎膜早破早产（PTB-PPROM）和医源性早产（PTB-M））之间的环境因素、社会人口学特征和临床特征，来描述和比较孕产妇及新生儿的流行病学特征。PTB-I和PTB-PPROM这两个亚型归为自发性早产（PTB-S）。
对2005年至2010年间在阿根廷图库曼省出生的1291例早产、无畸形、单胎活产的初产妇和经产妇进行了一项回顾性观察研究。比较了不同临床亚型之间的50多个孕产妇变量和10个新生儿变量。进行这些比较是为了确定早产亚型之间的异质性：（PTB-S）与（PTB-M），以及自发性亚型内部：（PTB-I）与（PTB-PPROM）。同样，使用两个条件逻辑多元回归来比较PTB-S和PTB-M之间以及PTB-I和PTB-PPROM之间的优势比（OR）。在比较孕产妇变量时匹配了孕产妇年龄，在比较婴儿变量时匹配了胎龄。
PTB-I亚型的特征是社会经济地位较低的年轻母亲，PTB-PPROM的特征是炎症过程导致的环境因素，PTB-M的特征是孕产妇或胎儿妊娠风险增加。
PTB-I和PTB-M的主要危险因素是既往有早产史；然而，既往自然流产不是危险因素，这表明存在一种生殖选择机制。
