Faculty of Health Sciences, Joyce and Irving Goldman Medical School, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Int J Gynaecol Obstet. 2022 Feb;156(2):336-340. doi: 10.1002/ijgo.13680. Epub 2021 Apr 15.
To identify risk factors in first pregnancy for perinatal mortality in the subsequent pregnancy.
A retrospective population-based nested case-control study was conducted, including all women with two first singleton consecutive deliveries. Women with perinatal mortality in their first pregnancy were excluded, and cases with perinatal mortality in the second pregnancy were compared with controls who delivered a live birth. Characteristics and complications of the first pregnancy were compared between the groups using multivariable logistic models.
A total of 43 043 women were included in the study, 385 (0.9%) were cases. Cases, as compared with controls (live births), were younger (22.62 ± 4.0 vs 23.22 ± 4.0 years), with shorter inter-pregnancy interval (1.38 ± 1.55 vs 1.56 ± 1.53 years), and were more likely to have the following complications in their first pregnancy: severe pre-eclampsia (3.4% vs 1.7%), small for gestational age (12.5% vs 8.0%), preterm delivery (17.7% vs 7.8%), and congenital or chromosomal malformations (9.6% vs 5.9%). In multivariable analysis the risk for perinatal mortality was greater with each additional complication (adjused odds ratio [aOR] 1.64, 95% confidence interval [CI] 1.30-2.07, P < 0.001; aOR 2.55, 95% CI 1.61-4.04, P < 0.001; aOR 7.88, 95% CI 3.81-16.29, P < 0.001 for one, two, and three or more complications, compared with no complications, respectively).
Complications in first pregnancy ending with live birth are associated with increased risk for perinatal mortality in a subsequent pregnancy.
确定首次妊娠中围产期死亡的危险因素，以便预测后续妊娠中的围产期死亡。
这是一项基于人群的回顾性巢式病例对照研究，纳入了所有首次连续分娩为单胎活产的女性。排除首次妊娠围产儿死亡的女性，并比较第二次妊娠围产儿死亡的病例与分娩活产儿的对照组。采用多变量逻辑模型比较两组间首次妊娠的特征和并发症。
共纳入 43043 名女性，其中 385 名（0.9%）为病例。与对照组（活产儿）相比，病例组年龄更小（22.62±4.0 岁 vs 23.22±4.0 岁），孕次间隔更短（1.38±1.55 年 vs 1.56±1.53 年），且首次妊娠时更可能发生以下并发症：重度子痫前期（3.4% vs 1.7%）、小于胎龄儿（12.5% vs 8.0%）、早产（17.7% vs 7.8%）和先天性或染色体畸形（9.6% vs 5.9%）。多变量分析显示，每增加一种并发症，围产期死亡的风险就会增加（调整后的比值比[aOR] 1.64，95%置信区间[CI] 1.30-2.07，P<0.001；aOR 2.55，95% CI 1.61-4.04，P<0.001；aOR 7.88，95% CI 3.81-16.29，P<0.001，与无并发症相比，分别有 1、2 和 3 种或更多并发症）。
首次妊娠活产后的并发症与后续妊娠中围产期死亡的风险增加有关。
