Wainstock Tamar, Sergienko Ruslan, Sheiner Eyal
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8489325, Israel.
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8489325, Israel.
J Clin Med. 2021 Apr 5;10(7):1517. doi: 10.3390/jcm10071517.
(1) Background: Preterm deliveries (PTD, <37 gestational weeks) which occur in 5-18% of deliveries across the world, are associated with immediate and long-term offspring morbidity, as well as high costs to health systems. Our aim was to identify risk factors during the first pregnancy ending at term for PTD in the subsequent pregnancy. (2) Methods: A retrospective population- based nested case-control study was conducted, including all women with two first singleton consecutive deliveries. Women with PTD in the first pregnancy were excluded. Characteristics and complications of the first pregnancy were compared among cases, defined as women with PTD in their second pregnancy, and the controls, defined as women delivering at term in their second pregnancy. A multivariable logistic regression model was used to study the association between pregnancy complications (in the first pregnancy) and PTD (in the subsequent pregnancy), while adjusting for maternal age and the interpregnancy interval. (3) Results: A total of 39,780 women were included in the study, 5.2% ( = 2088) had PTD in their second pregnancy. Women with PTD, as compared to controls (i.e., delivered at term in second pregnancy), were more likely to have the following complications in their first pregnancy: perinatal mortality (0.4% vs. 1.0%), small for gestational age (12.4% vs. 8.1%), and preeclampsia (7.6% vs. 5.7%). In the multivariable model, after adjusting for maternal age, interpregnancy interval and co-morbidities, having any one of these first pregnancy complications was independently associated with an increased risk for PTD (adjusted OR = 1.44; 95%CI 1.28-1.62), and the risk was greater if two or more complications were diagnosed (adjusted OR = 2.09; 95%CI 1.47-3.00). These complications were also risk factors for early PTD (<34 gestational weeks), PTD with a systematic infectious disease in the background, and possibly with spontaneous PTD. (4) Conclusions: First pregnancy complications are associated with an increased risk for PTD in the subsequent pregnancy. First pregnancy, although ending at term, may serve as a window of opportunity to identify women at risk for future PTD.
（1）背景：全球5%-18%的分娩为早产（妊娠<37周），这与子代近期及远期发病相关，同时给卫生系统带来高昂成本。我们的目的是确定首次足月妊娠时的危险因素，以预测后续妊娠中的早产情况。（2）方法：开展一项基于人群的回顾性巢式病例对照研究，纳入所有有两次连续单胎初产的女性。排除首次妊娠为早产的女性。比较病例组（定义为第二次妊娠早产的女性）和对照组（定义为第二次妊娠足月分娩的女性）首次妊娠的特征及并发症情况。采用多变量逻辑回归模型研究（首次妊娠时的）妊娠并发症与（后续妊娠中的）早产之间的关联，并对产妇年龄及两次妊娠间隔进行校正。（3）结果：共纳入39780名女性，其中5.2%（n=2088）第二次妊娠早产。与对照组（即第二次妊娠足月分娩者）相比，早产女性首次妊娠时更易出现以下并发症：围产儿死亡（0.4%对1.0%）、小于胎龄儿（12.4%对8.1%）及子痫前期（7.6%对5.7%）。在多变量模型中，校正产妇年龄、两次妊娠间隔及合并症后，首次妊娠出现上述任何一种并发症均独立增加早产风险（校正OR=1.44；95%CI 1.28-1.62），若诊断出两种或更多并发症，风险更高（校正OR=2.09；95%CI 1.47-3.00）。这些并发症也是早期早产（妊娠<34周）、伴有系统性感染疾病背景的早产以及可能的自发性早产的危险因素。（4）结论：首次妊娠并发症与后续妊娠早产风险增加相关。首次妊娠虽为足月分娩，但可作为识别未来早产高危女性的机会窗口。
