Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
Comisión de Investigaciones Científicas, Buenos Aires, Argentina.
Pediatr Res. 2022 Jun;91(7):1882-1889. doi: 10.1038/s41390-021-01659-4. Epub 2021 Jul 19.
The aim of this study was to determine the mediating effect of spontaneous preterm birth (PTB) main predictors that would allow to suggest etiological pathways.
We carried out a case-control study, including sociodemographic characteristics, habits, health care, and obstetric data of multiparous women who gave birth at a maternity hospital from Tucumán, Argentina, between 2005 and 2010: 998 women without previous PTB who delivered at term and 562 who delivered preterm. We selected factors with the greatest predictive power using a penalized logistic regression model. A data-driven Bayesian network including the selected factors was created where we identified pathways and performed mediation analyses.
We identified three PTB pathways whose natural indirect effect was greater than zero with a 95% confidence interval: maternal age less than 20 years mediated by few prenatal visits, vaginal bleeding in the first trimester mediated by vaginal bleeding in the second trimester, and urinary tract infection mediated by vaginal bleeding in the second trimester. The effect mediated in these pathways showed greater sensitivity to confounders affecting the variables mediator-outcome and exposure-mediator in the same direction.
The identified pathways suggest PTB etiological lines related to social disparities and exposure to genitourinary tract infections.
Few prenatal visits (<5) and vaginal bleeding are two of the main predictors for spontaneous preterm birth in the studied population. Few prenatal visits mediates part of the risk associated with maternal age less than 20 years and vaginal bleeding in the second trimester mediates part of the risk associated with vaginal bleeding in the first trimester and with urinary tract infection. Social disparities and exposure to genitourinary tract infections would be etiological lines of spontaneous preterm birth.
本研究旨在确定自发性早产（PTB）主要预测因素的中介效应，以便提出病因途径。
我们进行了一项病例对照研究，纳入了 2005 年至 2010 年期间在阿根廷图库曼一家妇产医院分娩的多产妇的社会人口统计学特征、习惯、医疗保健和产科数据：998 名无既往早产史的足月分娩妇女和 562 名早产妇女。我们使用惩罚逻辑回归模型选择具有最大预测能力的因素。创建了一个包含选定因素的数据驱动贝叶斯网络，我们在其中确定了途径并进行了中介分析。
我们确定了三个 PTB 途径，其自然间接效应大于零，置信区间为 95%：由产前就诊次数少介导的 20 岁以下母亲年龄、由第二个三个月阴道出血介导的第一个三个月阴道出血、以及由第二个三个月阴道出血介导的尿路感染。在这些途径中，中介效应更易受到影响变量中介结果和暴露中介的混杂因素的影响，这些混杂因素朝着相同的方向影响变量。
确定的途径表明与社会差异和生殖道感染暴露有关的 PTB 病因线。
产前就诊次数少（<5）和阴道出血是研究人群中自发性早产的两个主要预测因素。产前就诊次数少部分介导了与 20 岁以下母亲年龄相关的风险，第二个三个月阴道出血部分介导了与第一个三个月阴道出血相关的风险，以及与尿路感染相关的风险。社会差异和生殖道感染暴露将是自发性早产的病因途径。
