Paz Levy Dorit, Sheiner Eyal, Wainstock Tamar, Sergienko Ruslan, Landau Daniella, Walfisch Asnat
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Am J Obstet Gynecol. 2017 Nov;217(5):588.e1-588.e11. doi: 10.1016/j.ajog.2017.07.015. Epub 2017 Jul 18.
Prematurity is known to be associated with high rates of endocrine and metabolic complications in the offspring. Offspring born early term (37-38 6/7 weeks' gestation) were also shown to exhibit long-term morbidity resembling that of late preterm, in several health categories.
We aimed to determine whether early term delivery impacts on the long-term endocrine and metabolic health of the offspring.
A population-based cohort analysis was performed, including all term singleton deliveries occurring from 1991 through 2013 at a single regional tertiary medical center. Congenital malformations and multiple pregnancies were excluded. Gestational age upon delivery was subdivided into early term deliveries and deliveries occurring at full term and later (≥39 weeks' gestation, comparison group). Endocrine and metabolic morbidity (including diabetes, obesity, hypoglycemia, hyperlipidemia, and hypothyroidism) of the offspring, up to the age of 18 years, was evaluated according to hospitalization files. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence. A Weibull parametric survival model was used to control for time to event, siblings, and other confounders.
During the study period 225,260 term deliveries met the inclusion criteria. Of them, 24% (n = 54,073) occurred at early term. Endocrine and metabolic morbidity was significantly more common in the early term group (0.51% vs 0.41%, P = .003). Specifically, overweight and obesity were more common among the early term group (P = .002). Differences were more prominent among children >5 years, who exhibited higher rates of type 1 diabetes mellitus, as well as obesity, when born at early term (P < .05). The survival curves demonstrated higher cumulative incidence of total endocrine and metabolic morbidity in the early term group. Using the Weibull parametric survival model, while controlling for siblings, maternal diabetes, hypertension, labor induction, and Apgar score, early term delivery exhibited an independent association with long-term childhood endocrine and metabolic morbidity of the offspring (adjusted hazard ratio, 1.17; 95% confidence interval, 1.01-1.34) and more so for age >5 years (adjusted hazard ratio, 1.30; 95% confidence interval, 1.08-1.56).
Deliveries occurring at early term are associated with higher rates of long-term pediatric endocrine and metabolic morbidity of the offspring as compared with deliveries occurring at a later gestational age. This association may be due to absence of full maturity of the hormonal axis in early term neonates or, alternatively, suggest an underlying fetal endocrine dysfunction as the initial mechanism responsible for spontaneous early term delivery.
众所周知，早产与后代内分泌和代谢并发症的高发生率相关。在几个健康类别中，早期足月出生（妊娠37 - 38⁶/₇周）的后代也显示出类似晚期早产的长期发病率。
我们旨在确定早期足月分娩是否会影响后代的长期内分泌和代谢健康。
进行了一项基于人群的队列分析，纳入了1991年至2013年在一家地区三级医疗中心发生的所有足月单胎分娩。排除先天性畸形和多胎妊娠。分娩时的孕周细分为早期足月分娩和足月及更晚期（≥39周妊娠，对照组）分娩。根据住院病历评估后代至18岁时的内分泌和代谢疾病（包括糖尿病、肥胖、低血糖、高脂血症和甲状腺功能减退）。采用Kaplan-Meier生存曲线比较累积发病率。使用Weibull参数生存模型来控制事件发生时间、兄弟姐妹及其他混杂因素。
在研究期间，225,260例足月分娩符合纳入标准。其中，24%（n = 54,073）为早期足月分娩。早期足月分娩组的内分泌和代谢疾病明显更常见（0.51%对0.41%，P = 0.003）。具体而言，超重和肥胖在早期足月分娩组中更常见（P = 0.002）。在5岁以上儿童中差异更为显著，这些儿童早期足月出生时患1型糖尿病以及肥胖的发生率更高（P < 0.05）。生存曲线显示早期足月分娩组的内分泌和代谢疾病总累积发病率更高。使用Weibull参数生存模型，在控制兄弟姐妹、母亲糖尿病、高血压、引产和阿氏评分后，早期足月分娩与后代儿童期长期内分泌和代谢疾病存在独立关联（调整后的风险比为1.17；95%置信区间为1.01 - 1.34），5岁以上儿童的关联更强（调整后的风险比为1.30；95%置信区间为1.08 - 1.56）。
与孕周较大时的分娩相比，早期足月分娩与后代更高的长期儿科内分泌和代谢疾病发生率相关。这种关联可能是由于早期足月新生儿激素轴未完全成熟，或者提示潜在的胎儿内分泌功能障碍是导致自发早期足月分娩的初始机制。
