Wilmink Freke A, Reijnierse Joyce, Reiss Irwin K M, Steegers Eric A P, de Jonge Rogier C J
Department of Obstetrics and Gynaecology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
Department of Paediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands.
Pregnancy Hypertens. 2019 Jan;15:57-63. doi: 10.1016/j.preghy.2018.11.001. Epub 2018 Nov 10.
Bronchopulmonary dysplasia (BPD) is a severe common complication of preterm birth with considerable short and long-term consequences. As more evidence is emerging that dysregulation of angiogenesis is implicated in the pathogenesis of preeclampsia as well as in fetal lung development, we assessed if preeclampsia is associated with development of BPD in very preterm neonates.
A retrospective cohort study of 308 infants born between 24 and 31 weeks of gestation in 2011 and 2012. We performed association analysis with univariable and multivariable logistic regression, adjusting for confounders. Models were additionally adjusted for intermediates, to show how an association can be disguised by over adjusting.
BPD was diagnosed at 36 weeks postmenstrual age and defined as the need for oxygen (FiO2 > 0.21) for at least 12 h per day, for more than 28 days before or at 36 weeks postmenstrual age, and classified as mild, moderate or severe.
After applying our exclusion criteria, we report our primary outcome on 247 mother-neonate pairs. Fifty-nine neonates developed BPD (23.9%) which was moderate to severe in 27 of them (10.9%). Preeclampsia was associated with BPD, adjusted odds ratio, 95% confidence interval: 4.22 (1.63, 10.91). However, after adjusting for additional intermediates no statistical significance remained, adjusted odds ratio, 95% confidence interval: 1.87 (0.49, 7.24).
This study shows that early-onset preeclampsia is associated with development of BPD in the very preterm neonate. Part of this association is mediated by fetal growth restriction and mode of delivery.
支气管肺发育不良（BPD）是早产的一种严重常见并发症，会造成相当多的短期和长期后果。鉴于越来越多的证据表明血管生成失调与子痫前期的发病机制以及胎儿肺发育有关，我们评估了子痫前期是否与极早产儿BPD的发生有关。
对2011年和2012年孕周在24至31周之间出生的308例婴儿进行回顾性队列研究。我们采用单变量和多变量逻辑回归进行关联分析，并对混杂因素进行校正。模型还针对中介变量进行了调整，以显示过度调整如何掩盖关联。
在月经龄36周时诊断BPD，定义为在月经龄36周之前或之时，每天需要吸氧（FiO2>0.21）至少12小时，持续超过28天，并分为轻度、中度或重度。
应用我们的排除标准后，我们报告了247对母婴的主要结局。59例新生儿发生了BPD（23.9%），其中27例（10.9%）为中度至重度。子痫前期与BPD有关，校正比值比，95%置信区间：4.22（1.63，10.91）。然而，在对其他中介变量进行调整后，不再有统计学意义，校正比值比，95%置信区间：1.87（0.49，7.24）。
本研究表明，早发型子痫前期与极早产儿BPD的发生有关。这种关联部分由胎儿生长受限和分娩方式介导。
