Stroustrup Annemarie, Plafkin Callie, Tran Thuy-An, Savitz David A
Division of Newborn Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, N.Y., USA.
Neonatology. 2016;109(4):248-54. doi: 10.1159/000442082. Epub 2016 Feb 10.
Fetomaternal hemorrhage (FMH) signifies failure of the placental barrier with whole blood transfer. Fetal anemia following FMH is associated with significant morbidity and mortality. If FMH is identified early, fetal anemia can be treated to minimize adverse outcomes. Risk factors for FMH are not known, limiting efforts to provide targeted screening for FMH.
To identify maternal and/or pregnancy characteristics associated with FMH that are recognizable prior to fetal morbidity.
This is the first published case-control study of FMH. Cases were identified from a prospectively maintained database of all hospital births between 1988 and 2010. Each case was matched to 4 controls by date and time of birth, allowing for assessment of a wide range of clinical and demographic data. Logistic regression modeling was used to assess the association between demographic and clinical characteristics and the diagnosis of FMH.
A total of 23 mother-baby pairs impacted by FMH and 92 matched controls were evaluated. Compared to controls, case mothers were more likely to have private insurance and to work outside the home and at night during pregnancy. Cases were more likely to be delivered preterm, but preterm labor was not more common among cases. There was no difference in race/ethnicity of cases compared to controls.
Severe FMH is associated with significant morbidity and mortality of the affected neonate. Women with FMH were more likely to work outside the home during pregnancy than women with normal pregnancies. This finding has implications for third-trimester screening of pregnant women who work in strenuous fields.
胎儿-母体出血（FMH）意味着胎盘屏障功能失效，导致全血转移。FMH后发生的胎儿贫血与显著的发病率和死亡率相关。如果能早期识别FMH，就可以对胎儿贫血进行治疗，以尽量减少不良后果。FMH的危险因素尚不清楚，这限制了针对FMH进行靶向筛查的努力。
确定与FMH相关的、在胎儿发病前可识别的母体和/或妊娠特征。
这是首次发表的关于FMH的病例对照研究。病例来自一个前瞻性维护的1988年至2010年间所有医院分娩的数据库。根据出生日期和时间，将每个病例与4名对照进行匹配，以便评估广泛的临床和人口统计学数据。采用逻辑回归模型评估人口统计学和临床特征与FMH诊断之间的关联。
共评估了23对受FMH影响的母婴对和92名匹配对照。与对照相比，病例组母亲更有可能拥有私人保险，并且在怀孕期间外出工作且上夜班。病例组更有可能早产，但早产在病例组中并不更常见。病例组与对照组在种族/民族方面没有差异。
严重的FMH与受影响新生儿的显著发病率和死亡率相关。与正常妊娠的女性相比，患有FMH的女性在怀孕期间更有可能外出工作。这一发现对在高强度工作领域工作的孕妇的孕晚期筛查具有启示意义。
