Liang Yingyu, Zhang Lizi, Huang Lijun, Li Yulian, Chen Jingsi, Bi Shilei, Huang Minshan, Tan Hu, Lai Siying, Liang Jingying, Gu Shifeng, Jia Jinping, Wen Suiwen, Wang Zhijian, Cao Yinli, Wang Shaoshuai, Xu Xiaoyan, Feng Ling, Zhao Xianlan, Zhao Yangyu, Zhu Qiying, Qi Hongbo, Zhang Lanzhen, Li Hongtian, Du Lili, Chen Dunjin
Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
J Matern Fetal Neonatal Med. 2023 Dec;36(1):2192853. doi: 10.1080/14767058.2023.2192853.
To explore the association between inter-pregnancy intervals and placenta previa and placenta accreta spectrum among women who had prior cesarean deliveries with respect to maternal age at first cesarean delivery.
This retrospective study included clinical data from 9981 singleton pregnant women with a history of cesarean delivery at 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. The study population was divided into four groups (<2, 2-5, 5-10, ≥10 years of the interval) according to the inter-pregnancy interval. The rate of placenta previa and placenta accreta spectrum among the four groups was compared, and multivariate logistic regression was used to analyze the relationship between inter-pregnancy interval and placenta previa and placenta accreta spectrum with respect to maternal age at first cesarean delivery.
Compared to women aged 30-34 years old at first cesarean delivery, the risk of placenta previa (aRR, 1.48; 95% CI, 1.16-1.88) and placenta accreta spectrum (aRR, 1.74; 95% CI, 1.28-2.35) were higher among women aged 18-24. Multivariate regression results showed that women at 18-24 with <2 years intervals exhibited a 5.05-fold increased risk for placenta previa compared with those with 2-5-year intervals (aRR, 5.05; 95% CI, 1.13-22.51). In addition, women aged 18-24 with less than 2 years intervals had an 8.44 times greater risk of developing PAS than women aged 30-34 with 2 to 5 years intervals (aRR, 8.44; 95% CI, 1.82-39.26).
The findings of this study suggested that short inter-pregnancy intervals were associated with increased risks for placenta previa, and placenta accreta spectrum for women under 25 years at first cesarean delivery, which may be partly attributed to obstetrical outcomes.
探讨首次剖宫产时产妇年龄与既往有剖宫产史的女性再次妊娠间隔时间与前置胎盘及胎盘植入谱系疾病之间的关联。
这项回顾性研究纳入了2017年1月至2017年12月期间中国七个省份11家公立三级医院9981名单胎妊娠且有剖宫产史的孕妇的临床资料。根据再次妊娠间隔时间，将研究人群分为四组（间隔时间<2年、2 - 5年、5 - 10年、≥10年）。比较四组前置胎盘和胎盘植入谱系疾病的发生率，并采用多因素logistic回归分析首次剖宫产时产妇年龄与再次妊娠间隔时间和前置胎盘及胎盘植入谱系疾病之间的关系。
与首次剖宫产时年龄在30 - 34岁的女性相比，首次剖宫产时年龄在18 - 24岁的女性发生前置胎盘（调整后相对危险度，1.48；95%可信区间，1.16 - 1.88）和胎盘植入谱系疾病（调整后相对危险度，1.74；95%可信区间，1.28 - 2.35）的风险更高。多因素回归结果显示，首次剖宫产时年龄在18 - 24岁且间隔时间<2年的女性与间隔时间为2 - 5年的女性相比，发生前置胎盘的风险增加了5.05倍（调整后相对危险度，5.05；95%可信区间，1.13 - 22.51）。此外，首次剖宫产时年龄在18 - 24岁且间隔时间<2年的女性发生胎盘植入谱系疾病的风险比首次剖宫产时年龄在30 - 34岁且间隔时间为2至5年的女性高8.44倍（调整后相对危险度，8.44；95%可信区间，1.82 - 39.26）。
本研究结果表明，对于首次剖宫产时年龄在25岁以下的女性，再次妊娠间隔时间短与前置胎盘及胎盘植入谱系疾病风险增加有关，这可能部分归因于产科结局。
