Department of Social Medicine.
Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
Int J Epidemiol. 2017 Oct 1;46(5):1690-1698. doi: 10.1093/ije/dyx107.
Maternal short stature has been observed to increase the risk of preterm birth; however, the aetiology behind this phenomenon is unknown. We investigated whether preeclampsia, an obstetric complication that often leads to preterm delivery and is reported to have an inverse association with women's height, mediates this association.
We studied 218 412 women with no underlying diseases before pregnancy, who delivered singletons from 2005 to 2011 and were included in the Japan Society of Obstetrics and Gynecology perinatal database, which is a national multi-centre-based delivery database among tertiary hospitals. We assessed the risk of preterm delivery in relation to height using multivariate analysis, and how the association was mediated by risk of preeclampsia using mediation analysis.
Each 5-cm decrement in height was associated with significantly higher risk of preterm delivery [relative risk 1.20; 95% confidence interval (CI): 1.13, 1.27] and shorter gestational age (-0.30; 95% CI: -0.44, -0.16 weeks). Mediation analysis showed that the effect of shorter height on increased risk of preterm delivery, due to an indirect effect mediated through increased risk of preeclampsia, was substantial for shorter gestational age (48%), as well as risk of preterm delivery (28%). When examining the three subtypes of preterm delivery separately, mediated effect was largest for provider-initiated preterm delivery without premature rupture of membranes (PROM) (34%), compared with spontaneous preterm delivery without PROM (17%) or preterm delivery with PROM (0%).
Preeclampsia partially mediates the association between maternal short stature and preterm delivery.
已有研究观察到母亲身材矮小会增加早产的风险；然而，这种现象的病因尚不清楚。我们研究了子痫前期是否会介导这种关联，子痫前期是一种产科并发症，常导致早产，且据报道与女性身高呈负相关。
我们研究了 2005 年至 2011 年期间在日本妇产科协会围产数据库中纳入的 218412 名无潜在疾病的孕妇，这些孕妇单胎妊娠且分娩，该数据库是一家三级医院的全国多中心分娩数据库。我们使用多变量分析评估了身高与早产风险的关系，并使用中介分析评估了子痫前期风险在其中的中介作用。
身高每降低 5cm，早产风险显著增加[相对风险 1.20；95%置信区间（CI）：1.13，1.27]，且妊娠周数缩短[0.30；95%CI：-0.44，-0.16 周]。中介分析表明，由于子痫前期风险增加而导致的身高较短对早产风险增加的影响是显著的，其中间接效应通过中介作用占妊娠周数缩短（48%）和早产风险（28%）的比例较大。当分别检查三种类型的早产时，在没有胎膜早破（PROM）的医源性早产中，中介效应最大（34%），而在没有 PROM 的自发性早产（17%）或有 PROM 的早产（0%）中，中介效应较小。
子痫前期部分介导了母亲身材矮小与早产之间的关联。
