Coo Helen, Brownell Marni D, Ruth Chelsea, Flavin Michael, Au Wendy, Day Andrew G
Department of Pediatrics, Queen's University, Kingston, ON.
Department of Community Health Sciences, University of Manitoba, Winnipeg, MB; Manitoba Centre for Health Policy, Winnipeg, MB.
J Obstet Gynaecol Can. 2017 Nov;39(11):996-1007. doi: 10.1016/j.jogc.2017.04.039. Epub 2017 Jul 28.
Congenital anomalies are a serious public health issue, and relatively few modifiable risk factors have been identified. Our objective was to investigate one such potential risk factor, the interpregnancy interval (IPI).
We conducted a secondary analysis of data housed at the Manitoba Centre for Health Policy. In-hospital live births and stillbirths of at least 20 weeks' gestation were identified, and consecutive births to the same mother were grouped into sibling pairs to calculate the IPI for the younger siblings of each pair. Logistic regression models were fit to examine the association between the IPI and any congenital anomaly, as well as CNS and chromosomal anomalies, while controlling for potentially confounding sociodemographic and clinical factors.
Among 172 909 live births and stillbirths, the IPI was not significantly associated with congenital anomalies overall or with chromosomal anomalies. Short IPIs were associated with significantly increased odds of CNS anomalies relative to IPIs of 18-23 months (adjusted OR [aOR] for IPIs <6 months 2.15; 95% CI 1.48-3.12), whereas the aOR for IPIs ≥60 months was elevated but not statistically significant (aOR 1.50; 95% CI 0.96-2.34). In a sensitivity analysis in which the cohort was restricted to births from 2003 onwards (which yielded more complete data on health-related behaviours), the observed effect for IPIs shorter than 6 months and CNS anomalies was attenuated and no longer significant, but it remained elevated (aOR 1.65; 95% CI 0.85-3.24).
The findings for CNS anomalies warrant further investigation.
先天性异常是一个严重的公共卫生问题，而目前已确定的可改变风险因素相对较少。我们的目的是研究其中一个潜在风险因素，即妊娠间隔（IPI）。
我们对马尼托巴省卫生政策中心的数据进行了二次分析。确定了孕周至少为20周的住院活产和死产情况，并将同一母亲的连续分娩分组为同胞对，以计算每对中较年幼同胞的IPI。采用逻辑回归模型来检验IPI与任何先天性异常以及中枢神经系统和染色体异常之间的关联，同时控制可能产生混淆的社会人口统计学和临床因素。
在172909例活产和死产中，IPI与总体先天性异常或染色体异常均无显著关联。与18 - 23个月的IPI相比，较短的IPI与中枢神经系统异常的几率显著增加相关（IPI < 6个月时调整后的比值比[aOR]为2.15；95%置信区间[CI]为1.48 - 3.12），而IPI≥60个月时aOR升高但无统计学意义（aOR为1.50；95% CI为0.96 - 2.34）。在一项敏感性分析中，将队列限制在2003年以后的出生情况（可获得更完整的健康相关行为数据），观察到IPI短于6个月与中枢神经系统异常之间的效应减弱且不再显著，但仍有所升高（aOR为1.65；95% CI为0.85 - 3.24）。
关于中枢神经系统异常的研究结果值得进一步调查。
