Hanley Gillian E, Hutcheon Jennifer A, Kinniburgh Brooke A, Lee Lily
Perinatal Services BC, and the Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
Obstet Gynecol. 2017 Mar;129(3):408-415. doi: 10.1097/AOG.0000000000001891.
To examine the association between interpregnancy interval and maternal-neonate health when matching women to their successive pregnancies to control for differences in maternal risk factors and compare these results with traditional unmatched designs.
We conducted a retrospective cohort study of 38,178 women with three or more deliveries (two or greater interpregnancy intervals) between 2000 and 2015 in British Columbia, Canada. We examined interpregnancy interval (0-5, 6-11, 12-17, 18-23 [reference], 24-59, and 60 months or greater) in relation to neonatal outcomes (preterm birth [less than 37 weeks of gestation], small-for-gestational-age birth [less than the 10th centile], use of neonatal intensive care, low birth weight [less than 2,500 g]) and maternal outcomes (gestational diabetes, beginning the subsequent pregnancy obese [body mass index 30 or greater], and preeclampsia-eclampsia). We used conditional logistic regression to compare interpregnancy intervals within the same mother and unconditional (unmatched) logistic regression to enable comparison with prior research.
Analyses using the traditional unmatched design showed significantly increased risks associated with short interpregnancy intervals (eg, there were 232 preterm births [12.8%] in 0-5 months compared with 501 [8.2%] in the 18-23 months reference group; adjusted odds ratio [OR] for preterm birth 1.53, 95% confidence interval [CI] 1.35-1.73). However, these risks were eliminated in within-woman matched analyses (adjusted OR for preterm birth 0.85, 95% CI 0.71-1.02). Matched results indicated that short interpregnancy intervals were significantly associated with increased risk of gestational diabetes (adjusted OR 1.35, 95% CI 1.02-1.80 for 0-5 months) and beginning the subsequent pregnancy obese (adjusted OR 1.61, 95% CI 1.05-2.45 for 0-5 months and adjusted OR 1.43, 95% CI 1.10-1.87 for 6-11 months).
Previously reported associations between short interpregnancy intervals and adverse neonatal outcomes may not be causal. However, short interpregnancy interval is associated with increased risk of gestational diabetes and beginning a subsequent pregnancy obese.
在将女性与其连续妊娠进行匹配以控制孕产妇风险因素差异的情况下，研究妊娠间隔与母婴健康之间的关联，并将这些结果与传统的非匹配设计进行比较。
我们对2000年至2015年期间在加拿大不列颠哥伦比亚省有三次或更多次分娩（两次或更长妊娠间隔）的38178名女性进行了一项回顾性队列研究。我们研究了妊娠间隔（0 - 5个月、6 - 11个月、12 - 17个月、18 - 23个月[参照组]、24 - 59个月以及60个月及以上）与新生儿结局（早产[妊娠小于37周]、小于胎龄儿出生[小于第10百分位数]、新生儿重症监护的使用、低出生体重[小于2500克]）和孕产妇结局（妊娠期糖尿病、下次妊娠开始时肥胖[体重指数30或更高]以及子痫前期 - 子痫）之间的关系。我们使用条件逻辑回归来比较同一母亲内的妊娠间隔，并使用无条件（非匹配）逻辑回归以便与先前的研究进行比较。
使用传统非匹配设计的分析表明，妊娠间隔短与风险显著增加相关（例如，0 - 5个月有232例早产[12.8%]，而18 - 23个月参照组有501例[8.2%]；早产的调整比值比[OR]为1.53，95%置信区间[CI]为1.35 - 1.73）。然而，在女性内匹配分析中这些风险被消除了（早产的调整OR为0.85，95% CI为0.71 - 1.02）。匹配结果表明，妊娠间隔短与妊娠期糖尿病风险增加显著相关（0 - 5个月的调整OR为1.35，95% CI为1.02 - 1.80）以及下次妊娠开始时肥胖（0 - 5个月的调整OR为1.61，95% CI为1.05 - 2.45，6 - 11个月的调整OR为1.43，95% CI为1.10 - 1.87）。
先前报道的妊娠间隔短与不良新生儿结局之间的关联可能并非因果关系。然而，妊娠间隔短与妊娠期糖尿病风险增加以及下次妊娠开始时肥胖有关。
