劳动与 36-40 孕周新生儿呼吸结局的关系。
Association of Labor With Neonatal Respiratory Outcomes at 36-40 Weeks of Gestation.
机构信息
Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, Columbia University, New York, New York, University of Utah Health Sciences Center, Salt Lake City, Utah, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Pittsburgh, Pittsburgh, Pennsylvania, The Ohio State University, Columbus, Ohio, University of Alabama at Birmingham, Birmingham, Alabama, University of Texas Medical Branch, Galveston, Texas, Wayne State University, Detroit, Michigan, Brown University, Providence, Rhode Island, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas, and Oregon Health & Science University, Portland, Oregon; and the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
出版信息
Obstet Gynecol. 2019 Sep;134(3):495-501. doi: 10.1097/AOG.0000000000003415.
OBJECTIVE
To evaluate whether labor is associated with lower odds of respiratory morbidity among neonates born from 36 to 40 weeks of gestation and to assess whether this association varies by gestational age and maternal diabetic status.
METHODS
We conducted a secondary analysis of women in the Assessment of Perinatal Excellence obstetric cohort who delivered across 25 U.S. hospitals over a 3-year period. Women with a singleton liveborn nonanomalous neonate who delivered from 36 to 40 weeks of gestation were included in our analysis. Those who received antenatal corticosteroids, underwent amniocentesis for fetal lung maturity, or did not meet dating criteria were excluded. Our primary outcome was composite neonatal respiratory morbidity, which included respiratory distress syndrome, ventilator support, continuous positive airway pressure, or neonatal death. Maternal characteristics and neonatal outcomes between women who labored and those who did not were compared. Multivariable logistic regression models were used to evaluate the association between labor and the primary outcome. Interactions between labor and diabetes mellitus and labor and gestational age were tested.
RESULTS
Our analysis included 63,187 women who underwent labor and 10,629 who did not. There was no interaction between labor and diabetes mellitus (P=.90). However, there was a significant interaction between labor and gestational age (P=.01). In the adjusted model, labor was associated with lower odds of neonatal respiratory morbidity compared with no labor for neonates delivered from 36-39 weeks of gestation. A 1-week increase in gestational age was associated with a 1.2 times increase in the adjusted odds ratio for the neonatal outcome comparing labor and no labor.
CONCLUSION
Labor was associated with lower odds of the composite outcome among neonates delivered from 36-39 weeks of gestation. The magnitude of this association varied by gestational age. The association was similar for women with or without diabetes mellitus.
目的
评估 36 至 40 孕周分娩是否与新生儿呼吸道发病率降低相关，并评估这种关联是否因胎龄和产妇糖尿病状态而异。
方法
我们对在 3 年内跨越 25 家美国医院分娩的评估围产期卓越产科队列中的女性进行了二次分析。本分析纳入了单胎活产非畸形新生儿，且胎龄为 36 至 40 周的女性。排除了接受产前皮质激素治疗、进行胎儿肺成熟度羊膜穿刺术或不符合日期标准的女性。我们的主要结局是复合新生儿呼吸道发病率，包括呼吸窘迫综合征、呼吸机支持、持续气道正压或新生儿死亡。比较了分娩和未分娩女性的产妇特征和新生儿结局。使用多变量逻辑回归模型评估分娩与主要结局之间的关联。测试了分娩与糖尿病以及分娩与胎龄之间的交互作用。
结果
我们的分析纳入了 63187 名分娩的女性和 10629 名未分娩的女性。分娩与糖尿病之间无交互作用（P=0.90）。然而，分娩与胎龄之间存在显著交互作用（P=0.01）。在调整后的模型中，与未分娩相比，36-39 孕周分娩的新生儿呼吸道发病率较低。胎龄每增加 1 周，与未分娩相比，分娩与不分娩的新生儿结局的调整比值比增加 1.2 倍。
结论
与未分娩相比，36-39 孕周分娩与新生儿呼吸道发病率降低相关。这种关联的程度因胎龄而异。对于有或没有糖尿病的女性，这种关联是相似的。
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