Giamberardino W, Winn V D, Armstrong J
Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, USA.
Department of Obstetrics and Gynecology, Stanford University School of Medicine, USA.
J Pregnancy Neonatal Med. 2021;5(4).
Preterm birth is a major cause of adverse perinatal outcomes, including intraventricular hemorrhage (IVH). IVH has been shown to contribute to lasting neurological disability, however the role of maternal characteristics and potentially modifiable risk factors that contribute to these outcomes have not been well defined. We sought to determine predictors of IVH in pregnancies complicated by early preterm premature rupture of membranes (PPROM).
We performed a retrospective cohort study of all singleton pregnancies with early PPROM <32 weeks GA and delivery >22 weeks GA at University of Colorado Hospital (UCH) from 1/1/2007-12/31/2011. Clinically significant IVH (Grade III or IV) was the primary outcome of this study. To determine independent predictors of IVH we created a multivariate model including all univariate covariates with p-value of ≤ 0.10.
In our cohort (n=229), when adjusted for non-white race, younger maternal age and increased BMI were independent predictors of clinically significant IVH (OR=1.4 CI 1.04-1.79, p=0.03; OR 1.2 CI 1.04-1.33, p=0.01, respectively). Female gender was also found to be an independent predictor of poor 5 minute APGAR (OR=2.3 CI 1.06-5.28, p=0.04).
In our cohort, infants born to younger mothers or mothers with higher BMI appear to be at increased risk for clinically significant IVH. Interestingly, on further analysis, we found that female newborns had a 2-fold greater risk of poor 5 minute APGAR of less than 7. Given these data, larger studies are warranted to examine modifiable and non-modifiable risk pregnancy that may be associated with IVH and subsequent adverse neurological outcomes in pregnancies complicated by early PPROM.
早产是围产期不良结局的主要原因，包括脑室内出血（IVH）。已有研究表明IVH会导致永久性神经功能障碍，然而，母体特征和可能导致这些结局的可改变风险因素的作用尚未明确界定。我们试图确定合并早期胎膜早破（PPROM）的妊娠中IVH的预测因素。
我们对2007年1月1日至2011年12月31日在科罗拉多大学医院（UCH）发生的所有孕周小于32周的单胎妊娠且孕22周后分娩的早期PPROM病例进行了回顾性队列研究。具有临床意义的IVH（III级或IV级）是本研究的主要结局。为了确定IVH的独立预测因素，我们建立了一个多变量模型，纳入了所有p值≤0.10的单变量协变量。
在我们的队列（n = 229）中，校正非白人种族因素后，母亲年龄较小和BMI增加是具有临床意义的IVH的独立预测因素（OR = 1.4，CI 1.04 - 1.79，p = 0.03；OR 1.2，CI 1.04 - 1.33，p = 0.01）。还发现女性性别是5分钟阿氏评分不良的独立预测因素（OR = 2.3，CI 1.06 - 5.28，p = 0.04）。
在我们的队列中，母亲年龄较小或BMI较高的婴儿发生具有临床意义的IVH的风险似乎增加。有趣的是，进一步分析发现，女性新生儿5分钟阿氏评分低于7分的风险高出2倍。鉴于这些数据，有必要开展更大规模的研究，以探讨在合并早期PPROM的妊娠中，可能与IVH及随后不良神经结局相关的可改变和不可改变的妊娠风险因素。
