Brink L T, Gebhardt G S, Mason D, Groenewald C A, Odendaal H J
Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
S Afr Med J. 2019 Jan 31;109(2):102-106. doi: 10.7196/SAMJ.2019.v109i2.13438.
We present further analyses from the Safe Passage Study, where the effect of alcohol exposure during pregnancy on sudden infant death syndrome and stillbirth was investigated.
To describe pregnancy and neonatal outcome in a large prospective study where information on the outcome of pregnancy was known in >98.3% of participants and ultrasound was used to determine gestational age (GA).
As part of the Safe Passage Study of the PASS Network in Cape Town, South Africa, the outcomes of 6 866 singleton pregnancies were prospectively followed from recruitment in early pregnancy until the infant was 12 months old to assess pregnancy outcome. Fetal growth was assessed by z-scores of the birth weight, and GA at birth was derived from early ultrasound assessments. The effects of fetal growth restriction and preterm delivery on pregnancy outcome were determined.
There were 66 miscarriages, 107 stillbirths at ≥22 weeks' gestation, 66 stillbirths at ≥28 weeks' gestation, 29 and 18 neonatal deaths at ≥22 and ≥28 weeks' gestation, respectively, and 54 post-neonatal deaths (28 days - 12 months). The miscarriage rate was 9.6/1 000 and the infant mortality rate 12.4/1 000. Of the births, 13.8% were preterm. For deliveries at ≥22 and ≥28 weeks, the stillbirth rates were 15.7 and 9.8/1 000 deliveries, respectively. For deliveries at ≥22 and ≥28 weeks, the neonatal death rates were 4.3 and 2.7/1 000 live births, respectively. For these pregnancies the perinatal mortality rates were 20.0/1 000 (≥22 weeks) and 12.5/1 000 (≥28 weeks), respectively. Only 15.9% of stillbirths occurred during labour (in 15.9% of cases it was uncertain whether death had occurred during labour). In the majority of cases (68.2%) fetal death occurred before labour, and 82.2% of stillbirths and 62.1% of neonatal deaths occurred in deliveries before 37 weeks. Including the miscarriages, stillbirths and infant deaths, there were 256 pregnancy losses; 77.3% were associated with deliveries before 37 weeks. Only 1.8% of all the women were HIV-positive, whereas the HIV-positive rate was 3.7% among those who had stillbirths. Birth weight was below the 10th centile in 25.6% of neonatal and post-neonatal deaths compared with 17.7% of survivors.
Preterm birth and fetal growth restriction play significant roles in fetal, neonatal and infant losses.
我们展示了“安全通道研究”的进一步分析结果，该研究调查了孕期酒精暴露对婴儿猝死综合征和死产的影响。
在一项大型前瞻性研究中描述妊娠和新生儿结局，该研究中超过98.3%的参与者已知妊娠结局，并使用超声确定孕周（GA）。
作为南非开普敦PASS网络“安全通道研究”的一部分，对6866例单胎妊娠的结局进行前瞻性跟踪，从早孕招募开始直至婴儿12个月大，以评估妊娠结局。通过出生体重的z评分评估胎儿生长情况，出生时的孕周由早期超声评估得出。确定胎儿生长受限和早产对妊娠结局的影响。
有66例流产、107例孕22周及以上的死产、66例孕28周及以上的死产、分别有29例和18例孕22周及以上和孕28周及以上的新生儿死亡，以及54例新生儿后期死亡（28天至12个月）。流产率为9.6/1000，婴儿死亡率为12.4/1000。分娩中，13.8%为早产。对于孕22周及以上和孕28周及以上的分娩，死产率分别为15.7/1000次分娩和9.8/1000次分娩。对于孕22周及以上和孕28周及以上的分娩，新生儿死亡率分别为4.3/1000活产和2.7/1000活产。对于这些妊娠，围产期死亡率分别为20.0/1000（孕22周及以上）和12.5/1000（孕28周及以上）。仅15.9%的死产发生在分娩期间（15.9%的病例中不确定死亡是否发生在分娩期间）。在大多数病例（68.2%）中，胎儿死亡发生在分娩前，82.2%的死产和62.1%的新生儿死亡发生在37周前的分娩中。包括流产、死产和婴儿死亡，共有256例妊娠丢失；77.3%与37周前的分娩有关。所有女性中仅1.8%为HIV阳性，而死产女性中的HIV阳性率为3.7%。25.6%的新生儿和新生儿后期死亡的出生体重低于第10百分位数，而存活者的这一比例为17.7%。
早产和胎儿生长受限在胎儿、新生儿和婴儿丢失中起重要作用。
