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来自利雅得母婴多中心队列研究的早产儿、早期足月和晚期足月婴儿:队列特征。

Preterm, early term, and post-term infants from Riyadh mother and baby multicenter cohort study: The cohort profile.

机构信息

Clinical Sciences Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.

Research Chair of Evidence-Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.

出版信息

Front Public Health. 2022 Sep 13;10:928037. doi: 10.3389/fpubh.2022.928037. eCollection 2022.

Abstract

BACKGROUND

Birth before 37 or beyond 42 gestational weeks is associated with adverse neonatal and maternal outcomes. Studies investigating determinants and outcomes of these deliveries are scarce. The objective of this study was to determine the neonatal birth profile in relation to the gestational age at delivery and to evaluate its influence on the immediate maternal and neonatal outcomes.

METHODS

This is a multicenter cohort study of 13,403 women conducted in three hospitals in Riyadh. Collected data included sociodemographic characteristics, obstetric history, and physical and laboratory measurements. Regression models were developed to estimate the adjusted odds ratio (OR) and confidence intervals (CI) to determine factors associated with preterm, early term, and post-term births and to evaluate common maternal and neonatal risks imposed by deliveries outside the full term.

RESULTS

The incidence of preterm, early term, and post-term delivery was 8.4%, 29.8%, and 1.4%, respectively. Hypertensive events during pregnancy consistently increased the risk of all grades of preterm births, from more than 3-fold for late preterm (OR = 3.40, 95% CI = 2.21-5.23) to nearly 7-fold for extremely early preterm (OR = 7.11, 95% CI = 2.24-22.60). Early term was more likely to occur in older mothers (OR = 1.30, 95% CI = 1.13-1.49), grand multiparous (OR = 1.21, 95% CI = 1.06-1.38), pregestational diabetes (OR = 1.91, 95% CI = 1.49-2.44), and gestational diabetes women (OR = 1.18, 95% CI = 1.05-1.33). The risk of post-term birth was higher in primiparous. In preterm births, the adverse outcome of neonates having an APGAR score of <7 at 5 min and admission to neonatal intensive care units increased progressively as the gestational age decreased. Post-term births are 2-fold more likely to need induction of labor; meanwhile, preterm births were more likely to deliver by cesarean section.

CONCLUSION

This large cohort study was the first in Saudi Arabia to assess the delivery profile across a continuum of gestational age and the associated maternal and neonatal adverse outcomes of deliveries outside the full-term period. The study showed that the prevalence of preterm and post-term birth in Saudi Arabia is similar to the prevalence in other high-income countries. The immediate adverse pregnancy outcomes inversely increased with the decrease in gestational age at delivery. In addition, maternal age, hypertension, diabetes, and parity influenced the gestational age at delivery.

摘要

背景

妊娠 37 周前或 42 周后分娩与新生儿和产妇不良结局相关。研究分娩决定因素和结局的相关研究很少。本研究的目的是确定与分娩时的胎龄相关的新生儿出生特征,并评估其对产妇和新生儿即时结局的影响。

方法

这是一项在利雅得三家医院进行的多中心队列研究,共纳入了 13403 名女性。收集的数据包括社会人口学特征、产科史以及体格检查和实验室测量结果。采用回归模型来估计调整后的比值比(OR)和置信区间(CI),以确定与早产、早期足月和过期产相关的因素,并评估分娩时胎龄不在足月范围时对产妇和新生儿常见风险的影响。

结果

早产、早期足月和过期产的发生率分别为 8.4%、29.8%和 1.4%。妊娠期间的高血压事件持续增加所有程度早产的风险,从晚期早产(OR=3.40,95%CI=2.21-5.23)到极早期早产(OR=7.11,95%CI=2.24-22.60)增加超过 3 倍。年龄较大的产妇(OR=1.30,95%CI=1.13-1.49)、经产妇(OR=1.21,95%CI=1.06-1.38)、孕前糖尿病(OR=1.91,95%CI=1.49-2.44)和妊娠期糖尿病女性(OR=1.18,95%CI=1.05-1.33)更易发生早期足月产。初产妇发生过期产的风险更高。在早产中,新生儿在第 5 分钟时 APGAR 评分<7 分且需要入住新生儿重症监护病房的不良结局随着胎龄的降低而逐渐增加。过期产分娩需要引产的可能性增加一倍;而早产更有可能通过剖宫产分娩。

结论

这是沙特阿拉伯第一项评估连续胎龄分娩特征以及足月期外分娩相关产妇和新生儿不良结局的大型队列研究。研究表明,沙特阿拉伯早产和过期产的发生率与其他高收入国家相似。即刻妊娠不良结局随着分娩时胎龄的降低而呈反向增加。此外,产妇年龄、高血压、糖尿病和产次影响分娩时的胎龄。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5385/9516634/b02d9d699470/fpubh-10-928037-g0001.jpg

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