Department of Mathematics, SUNY College At Buffalo, A257 Buckham Hall, 1300 Elmwood Avenue, Buffalo, NY, 14222, USA.
Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 766 Irving Avenue, Syracuse, NY, 13210, USA.
Arch Gynecol Obstet. 2021 Feb;303(2):419-426. doi: 10.1007/s00404-020-05760-7. Epub 2020 Sep 8.
Many modifiable maternal behaviors and experiences before and during pregnancy are associated with adverse health outcomes. The relationship between a number of maternal and gestational disorders and perinatal outcomes (preterm birth, low birth weight and neonatal intensive care unit (NICU)) admission in the Central New York population is determined using the Statewide Perinatal Data System, in a retrospective population-based cohort study.
Singleton births excluding newborns with congenital anomalies among 165,739 women between 2004 and 2012 are included in this study. Multivariable logistic regression analysis is used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for maternal age, race, education, employment, parity, body mass index, smoking, drug use, depression, abortions, gender of child, prenatal care, and hospital level.
Previous preterm birth and vaginal bleeding are independent high-risk factors for all three perinatal outcomes, pre-pregnancy diabetes (OR 4.95, 95% CI 4.34, 5.64) for preterm birth and (OR 7.45, 95% CI 6.58, 8.44) for NICU admission; and gestational hypertension (OR 4.35, 95% CI 4.03, 4.70) for low birth weight. Among infections, bacterial vaginosis is retained in the multivariable model as a risk factor for preterm and low birth weight while hepatitis C is a risk factor for NICU admission.
Our findings suggest the continued importance of addressing the need to provide preconception and inter conception care for women since many modifiable risk factors are correlated and need to be addressed well before the woman becomes pregnant.
许多可改变的孕产妇行为和经验，无论是在怀孕前还是怀孕期间，都与不良健康结果有关。本研究采用纽约州围产期数据系统，通过回顾性人群队列研究，确定了该州中心地区的一些孕产妇和妊娠疾病与围产期结局（早产、低出生体重和新生儿重症监护病房（NICU）入住）之间的关系。
纳入了 2004 年至 2012 年间 165739 名单胎分娩的妇女（排除了先天性畸形新生儿），本研究采用多变量逻辑回归分析来估计比值比（OR）和 95%置信区间（CI），并根据母亲年龄、种族、教育、就业、产次、体重指数、吸烟、药物使用、抑郁、流产、子女性别、产前保健和医院级别进行调整。
既往早产和阴道出血是所有三种围产期结局的独立高危因素，孕前糖尿病（早产的 OR 4.95，95%CI 4.34-5.64）和（NICU 入住的 OR 7.45，95%CI 6.58-8.44）；妊娠期高血压（OR 4.35，95%CI 4.03-4.70）与低出生体重相关。在感染中，细菌性阴道病在多变量模型中仍然是早产和低出生体重的危险因素，而丙型肝炎是 NICU 入住的危险因素。
我们的研究结果表明，由于许多可改变的危险因素相互关联，并且需要在女性怀孕前很好地解决，因此继续需要为女性提供孕前和妊娠前护理。
