医疗及分娩手术干预对出生后28天及5岁以下儿童健康结局的影响：一项基于关联数据的人群队列研究。
The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: A linked data population-based cohort study.
作者信息
Peters Lilian L, Thornton Charlene, de Jonge Ank, Khashan Ali, Tracy Mark, Downe Soo, Feijen-de Jong Esther I, Dahlen Hannah G
机构信息
Department of Midwifery Science, VU University Medical Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
出版信息
Birth. 2018 Dec;45(4):347-357. doi: 10.1111/birt.12348. Epub 2018 Mar 25.
BACKGROUND
Spontaneous vaginal birth rates are decreasing worldwide, while cesarean delivery, instrumental births, and medical birth interventions are increasing. Emerging evidence suggests that birth interventions may have an effect on children's health. Therefore, the aim of our study was to examine the association between operative and medical birth interventions on the child's health during the first 28 days and up to 5 years of age.
METHODS
In New South Wales (Australia), population-linked data sets were analyzed, including data on maternal characteristics, child characteristics, mode of birth, interventions during labor and birth, and adverse health outcomes of the children (ie, jaundice, feeding problems, hypothermia, asthma, respiratory infections, gastrointestinal disorders, other infections, metabolic disorder, and eczema) registered with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification codes. Logistic regression analyses were performed for each adverse health outcome.
RESULTS
Our analyses included 491 590 women and their children; of those 38% experienced a spontaneous vaginal birth. Infants who experienced an instrumental birth after induction or augmentation had the highest risk of jaundice, adjusted odds ratio (aOR) 2.75 (95% confidence interval [CI] 2.61-2.91) compared with spontaneous vaginal birth. Children born by cesarean delivery were particularly at statistically significantly increased risk for infections, eczema, and metabolic disorder, compared with spontaneous vaginal birth. Children born by emergency cesarean delivery showed the highest association for metabolic disorder, aOR 2.63 (95% CI 2.26-3.07).
CONCLUSION
Children born by spontaneous vaginal birth had fewer short- and longer-term health problems, compared with those born after birth interventions.
背景
全球范围内自然阴道分娩率正在下降，而剖宫产、器械助产和医疗分娩干预措施却在增加。新出现的证据表明，分娩干预可能会对儿童健康产生影响。因此，我们研究的目的是探讨手术和医疗分娩干预与儿童出生后28天内及5岁前健康状况之间的关联。
方法
在澳大利亚新南威尔士州，对与人口相关的数据集进行了分析，包括产妇特征、儿童特征、分娩方式、分娩过程中的干预措施以及儿童不良健康结局（即黄疸、喂养问题、体温过低、哮喘、呼吸道感染、胃肠道疾病、其他感染、代谢紊乱和湿疹）的数据，这些数据采用《疾病和相关健康问题国际统计分类》第十次修订版澳大利亚修改编码进行登记。对每种不良健康结局进行逻辑回归分析。
结果
我们的分析纳入了491590名妇女及其子女；其中38%经历了自然阴道分娩。与自然阴道分娩相比，引产或加强宫缩后进行器械助产的婴儿患黄疸的风险最高，调整后的优势比（aOR）为2.75（95%置信区间[CI]为2.61 - 2.91）。与自然阴道分娩相比，剖宫产出生的儿童患感染、湿疹和代谢紊乱的风险在统计学上显著增加。急诊剖宫产出生的儿童患代谢紊乱的关联性最高，aOR为2.63（95%CI为2.26 - 3.07）。
结论
与出生干预后出生的儿童相比，自然阴道分娩出生的儿童短期和长期健康问题较少。
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