Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.
Paediatr Perinat Epidemiol. 2020 Nov;34(6):706-712. doi: 10.1111/ppe.12687. Epub 2020 Jun 16.
Chronic placental inflammation is associated with preterm birth (PTB) and perinatal mortality. Ferritin is often elevated in chronic inflammatory conditions, but prior studies of its relation to PTB were restricted to ferritin measurement within pregnancy, were underpowered to detect rarer outcomes, and did not account for pre-existing maternal inflammatory conditions, such as inflammatory bowel or rheumatological disease.
To evaluate whether an elevated ferritin level prior to pregnancy is associated with major adverse pregnancy outcomes.
A population-based cohort study was completed using Ontario, Canada. Included were all Ontarian women with a hospital livebirth or stillbirth at ≥20 weeks' gestation, 2007-2018, and serum haemoglobin and ferritin measured as an outpatient within 120 days before conception. Excluded were women with a diagnosed iron overload disorder or a ferritin concentration <15 µg/L. The main exposure was a pre-pregnancy serum ferritin ≥95th percentile. Study outcomes included PTB < 37 weeks' gestation, including clinician-initiated and spontaneous PTB; PTB < 32 weeks; chorioamnionitis; and perinatal death. Relative risks (RR) and 95% confidence intervals (CI) were calculated for each study outcome, comparing a serum ferritin concentration ≥95th vs <5th percentile (the referent), while adjusting maternal age, residence, haemoglobin concentration, diabetes mellitus, inflammatory bowel disease, illicit drug/tobacco use, chronic kidney disease, chronic hypertension, sickle-cell disease or thalassaemia, and rheumatological conditions.
Among 89 847 births, a preconceptional maternal serum ferritin ≥95th (112.0 μg/L) vs <5th (16.9 μg/L) percentile was associated with an adjusted relative risk (aRR) of 1.34 (95% CI 1.15, 1.57) for PTB, including spontaneous and clinician-initiated PTB. Results were equivocal for chorioamnionitis (aRR 1.23, 95% CI 0.81, 1.86), and there was no association with perinatal mortality (aRR 0.94, 95% CI 0.55, 1.61).
A high preconceptional ferritin concentration is associated with some adverse perinatal outcomes.
慢性胎盘炎症与早产（PTB）和围产儿死亡率有关。铁蛋白在慢性炎症情况下通常升高，但之前关于铁蛋白与 PTB 关系的研究仅限于妊娠期间的铁蛋白测量，检测罕见结局的能力不足，并且没有考虑到先前存在的母体炎症性疾病，如炎症性肠病或风湿性疾病。
评估妊娠前铁蛋白水平升高是否与主要不良妊娠结局相关。
本研究采用加拿大安大略省的一项基于人群的队列研究。纳入标准为 2007 年至 2018 年在 20 周以上妊娠时发生医院活产或死产的所有安大略省妇女，以及在受孕前 120 天内在门诊测量的血清血红蛋白和铁蛋白。排除标准为患有铁过载疾病或铁蛋白浓度<15μg/L 的妇女。主要暴露是妊娠前血清铁蛋白≥第 95 百分位数。研究结局包括<37 周的早产，包括临床医生启动的和自发性早产；<32 周的早产；绒毛膜羊膜炎；以及围产儿死亡。计算每个研究结局的相对风险（RR）和 95%置信区间（CI），比较血清铁蛋白浓度≥第 95 百分位与<第 5 百分位（参照），同时调整母亲年龄、居住地、血红蛋白浓度、糖尿病、炎症性肠病、非法药物/吸烟、慢性肾脏病、慢性高血压、镰状细胞病或地中海贫血、以及风湿性疾病。
在 89847 例分娩中，妊娠前母体血清铁蛋白≥第 95 百分位（112.0μg/L）与<第 5 百分位（16.9μg/L）相比，调整后的相对风险（aRR）为 1.34（95%CI 1.15，1.57），包括自发性和临床医生启动的早产。绒毛膜羊膜炎的结果模棱两可（aRR 1.23，95%CI 0.81，1.86），与围产儿死亡率无关联（aRR 0.94，95%CI 0.55，1.61）。
妊娠前高铁蛋白浓度与一些不良围产儿结局有关。
