Bénin Amélie, Blanc Matthieu, Chollat Clément, Jarreau Pierre-Henri, Goffinet François, Tsatsaris Vassilis, Delorme Pierre
Maternité Port-Royal, AP-HP, APHP. Centre-Université de Paris, FHU PREMA, Paris, France(1).
Maternité Port-Royal, Service de réanimation néonatale, AP-HP, APHP. Centre-Université de Paris, Paris, France.
J Gynecol Obstet Hum Reprod. 2020 Sep 22:101920. doi: 10.1016/j.jogoh.2020.101920.
Recent studies have shown that the cause of very preterm births may be related to neonatal morbidity and mortality. Even though these risks are lower among late preterm births, this group accounts for the vast majority of all preterm births. The objective of this study was to evaluate the relation of neonatal morbidity and mortality to the cause of late preterm birth.
This retrospective observational cohort study included all women who gave birth to liveborn singletons from 34 to 36 weeks+6 days of gestation in a French level III maternity hospital in the 5-year period 2013-2017. The causes of preterm delivery were divided into 6 mutually exclusive groups. The main outcome was a composite neonatal morbidity criterion, defined by at least one among the following criteria: neonatal respiratory distress, neurological complications, neonatal sepsis, severe necrotizing enterocolitis, and neonatal hypoglycemia. We analyzed the association between cause of preterm delivery and neonatal morbidity after adjustment for gestational age and antenatal corticosteroid therapy. The reference group was preterm labor, defined by spontaneous preterm labor with intact membranes.
During the study period, there were a total of 27 110 births, including 1114 singleton births at 34 to 36 weeks of gestation + 6 days (4.1%). Among the 968 late preterm births included, the risk of neonatal morbidity in the group with preterm premature rupture of membranes (PPROM) was similar to that in the preterm labor (reference) group: adjusted odds ratio (aOR) 1.2 (95% CI, 0.8-1.8). All the other causes of late preterm birth were associated with a higher risk of neonatal morbidity than the reference group: aOR 2.0 [95% CI, 1.1-3.5] for hypertensive disorders without suspected fetal growth restriction (FGR) (9.1% of cases), aOR 2.4 [95% CI, 1.4-4.2] for hypertensive disorders with suspected FGR (8.9%), aOR 4.2 [95% CI, 2.2-8.0] for suspected FGR without hypertensive disorders (5.8%), and aOR 4.4 [95% CI, 2.2-8.8] for vaginal bleeding related to abnormal placental insertion (4.7%).
Among infants born from 34 to 36 weeks + 6 days of gestation, PPROM and preterm labor had similar risks of neonatal morbidity, while the other causes were associated with a risk of neonatal morbidity at least twice that with preterm labor.
近期研究表明，极早产的原因可能与新生儿发病率和死亡率相关。尽管晚期早产的这些风险较低，但这一群体占所有早产的绝大多数。本研究的目的是评估晚期早产原因与新生儿发病率和死亡率之间的关系。
这项回顾性观察队列研究纳入了2013年至2017年期间在法国一家三级妇产医院分娩的所有孕34至36周+6天的单胎活产妇女。早产原因分为6个相互排斥的组。主要结局是一个综合新生儿发病标准，由以下至少一项标准定义：新生儿呼吸窘迫、神经并发症、新生儿败血症、严重坏死性小肠结肠炎和新生儿低血糖。我们在调整孕周和产前糖皮质激素治疗后分析了早产原因与新生儿发病率之间的关联。参照组为早产临产，定义为胎膜完整的自发性早产临产。
在研究期间，共有27110例分娩，其中包括1114例孕34至36周+6天的单胎分娩（4.1%）。在纳入的968例晚期早产中，胎膜早破早产（PPROM）组的新生儿发病风险与早产临产（参照）组相似：调整后的优势比（aOR）为1.2（95%可信区间，0.8 - 1.8）。所有其他晚期早产原因与参照组相比，新生儿发病风险更高：无疑似胎儿生长受限（FGR）的高血压疾病组aOR为2.0 [95%可信区间，1.1 - 3.5]（占病例的9.1%），有疑似FGR的高血压疾病组aOR为2.4 [95%可信区间，1.4 - 4.2]（8.9%），无高血压疾病的疑似FGR组aOR为4.2 [95%可信区间，2.2 - 8.0]（5.8%），与胎盘异常植入相关的阴道出血组aOR为4.4 [95%可信区间，2.2 - 8.8]（4.7%）。
在孕34至36周+6天出生的婴儿中，PPROM和早产临产的新生儿发病风险相似，而其他原因与至少是早产临产两倍的新生儿发病风险相关。
