Monari Francesca, Chiossi Giuseppe, Gargano Giancarlo, Ballarini Michela, Baronciani Dante, Coscia Alessandra, Facchinetti Fabio
Dipartimento di Scienze Mediche e Chirurgiche Materno-infantili e dell'adulto, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.
Mother-Infant Department, Modena Policlinico Hospital, University of Modena and Reggio Emilia, Modena, Italy.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):8257-8266. doi: 10.1080/14767058.2021.1969358. Epub 2022 Jan 25.
The late preterm (LP) rate in Western countries is 3-6% of all births, accounting for about two-thirds of the entire preterm population. However, all LP babies are not the same.
To identify pregnancies at risk for adverse outcomes in the LP period, we investigated how gestational age (GA) at delivery, delivery indication and prenatal risk factors may affect neonatal outcomes.
Prospective cohort study among singleton infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013-2015.
The primary outcome was a composite of adverse perinatal outcomes. Multivariate logistic regression models were used to, respectively, investigate the effects of GA at delivery, circumstances at parturition and prenatal risk factors, on study outcomes after controlling for confounding variable.
Among 1867 births, 302, 504, and 1061 infants were born at 34, 35, and 36 weeks, respectively. There were no neonatal deaths. An increased risk of composite neonatal outcome was observed among 34 and 35 weeks deliveries compared with 36 weeks, and among indicated deliveries compared with spontaneous. When studying prenatal risk factors, neonatal morbidity was associated with pre gestational diabetes, preterm premature rupture of membranes (pPROM), maternal obesity, bleeding and polyhydramnios; instead, preeclampsia had a protective effect.
LP with indicated deliveries at 34 or 35 weeks, or with specific prenatal risk factors have worse neonatal outcome when compared to 36. Such differences should be considered when counseling patients and planning interventions such as timing of delivery in LP period.
西方国家晚期早产儿（LP）的发生率占所有出生人口的3%-6%，约占整个早产人口的三分之二。然而，并非所有LP婴儿情况都相同。
为了确定LP期有不良结局风险的妊娠，我们研究了分娩时的孕周（GA）、分娩指征和产前危险因素如何影响新生儿结局。
2013年至2015年期间，在意大利艾米利亚-罗马涅对34+0至36+6周出生的单胎婴儿进行前瞻性队列研究。
主要结局是围产期不良结局的综合指标。多因素逻辑回归模型分别用于在控制混杂变量后，研究分娩时的GA、分娩情况和产前危险因素对研究结局的影响。
在1867例出生中，分别有302例、504例和1061例婴儿在34周、35周和36周出生。无新生儿死亡。与36周分娩相比，34周和35周分娩时观察到综合新生儿结局风险增加；与自然分娩相比，指征性分娩时风险增加。在研究产前危险因素时，新生儿发病率与孕前糖尿病、胎膜早破（pPROM）、母亲肥胖、出血和羊水过多有关；相反，子痫前期有保护作用。
与36周相比，34或35周的指征性LP分娩或伴有特定产前危险因素的LP分娩有更差的新生儿结局。在为患者提供咨询和规划干预措施（如LP期分娩时机）时，应考虑这些差异。
