Department of Global Public Health and Primary Care, University of Bergen, Postbox 7804, N-5020 Bergen, Norway
Department of Biomedicine, University of Bergen, Bergen, Norway.
BMJ. 2020 Apr 29;369:m1007. doi: 10.1136/bmj.m1007.
To explore conditions and outcomes of a first delivery at term that might predict later preterm birth.
Population based, prospective register based study.
Medical Birth Registry of Norway, 1999-2015.
302 192 women giving birth (live or stillbirth) to a second singleton child between 1999 and 2015.
Main outcome was the relative risk of preterm delivery (<37 gestational weeks) in the birth after a term first birth with pregnancy complications: pre-eclampsia, placental abruption, stillbirth, neonatal death, and small for gestational age.
Women with any of the five complications at term showed a substantially increased risk of preterm delivery in the next pregnancy. The absolute risks for preterm delivery in a second pregnancy were 3.1% with none of the five term complications (8202/265 043), 6.1% after term pre-eclampsia (688/11 225), 7.3% after term placental abruption (41/562), 13.1% after term stillbirth (72/551), 10.0% after term neonatal death (22/219), and 6.7% after term small for gestational age (463/6939). The unadjusted relative risk for preterm birth after term pre-eclampsia was 2.0 (95% confidence interval 1.8 to 2.1), after term placental abruption was 2.3 (1.7 to 3.1), after term stillbirth was 4.2 (3.4 to 5.2), after term neonatal death was 3.2 (2.2 to 4.8), and after term small for gestational age was 2.2 (2.0 to 2.4). On average, the risk of preterm birth was increased 2.0-fold (1.9-fold to 2.1-fold) with one term complication in the first pregnancy, and 3.5-fold (2.9-fold to 4.2-fold) with two or more complications. The associations persisted after excluding recurrence of the specific complication in the second pregnancy. These links between term complications and preterm delivery were also seen in the reverse direction: preterm birth in the first pregnancy predicted complications in second pregnancies delivered at term.
Pre-eclampsia, placental abruption, stillbirth, neonatal death, or small for gestational age experienced in a first term pregnancy are associated with a substantially increased risk of subsequent preterm delivery. Term complications seem to share important underlying causes with preterm delivery that persist from pregnancy to pregnancy, perhaps related to a mother's predisposition to disorders of placental function.
探讨足月分娩时的某些情况和结局是否可预测随后的早产。
基于人群的前瞻性登记研究。
挪威医学出生登记处，1999-2015 年。
1999 年至 2015 年间，302192 名分娩（活产或死产）第二胎且为单胎的女性。
主要结局是足月分娩后首次妊娠出现妊娠并发症（子痫前期、胎盘早剥、死胎、新生儿死亡和小于胎龄儿）与早产（<37 孕周）的相对风险。
足月分娩时出现上述 5 种并发症之一的女性，其下次妊娠发生早产的风险显著增加。第二次妊娠早产的绝对风险分别为：无 5 种足月期并发症者为 3.1%（8202/265043），足月期子痫前期者为 6.1%（688/11225），足月期胎盘早剥者为 7.3%（41/562），足月期死胎者为 13.1%（72/551），足月期新生儿死亡者为 10.0%（22/219），足月期小于胎龄儿者为 6.7%（463/6939）。足月期子痫前期后早产的未调整相对风险为 2.0（95%置信区间 1.8 至 2.1），足月期胎盘早剥后为 2.3（1.7 至 3.1），足月期死胎后为 4.2（3.4 至 5.2），足月期新生儿死亡后为 3.2（2.2 至 4.8），足月期小于胎龄儿后为 2.2（2.0 至 2.4）。第一次妊娠有 1 种足月期并发症时，早产风险平均增加 2.0 倍（1.9 倍至 2.1 倍），有 2 种或以上并发症时增加 3.5 倍（2.9 倍至 4.2 倍）。第二次妊娠再次出现特定并发症时，这些关联仍然存在。这些足月期并发症与早产之间的关联在相反方向也存在：第一次妊娠早产预测第二次妊娠足月分娩时出现并发症。
首次足月妊娠时出现子痫前期、胎盘早剥、死胎、新生儿死亡或小于胎龄儿与随后早产的风险显著增加相关。足月期并发症似乎与早产存在重要的共同潜在病因，这种病因可能与胎盘功能障碍的母体易感性有关。
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