Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, USA.
Intermountain Healthcare, Women and Newborns Clinical Program, Salt Lake City, Utah, USA.
BJOG. 2023 Nov;130(12):1483-1490. doi: 10.1111/1471-0528.17552. Epub 2023 May 22.
To determine whether women with spontaneous preterm birth (PTB) have increased risks for long-term mortality.
Retrospective cohort.
Births in Utah between 1939 and 1977.
We included women with a singleton live birth ≥20 weeks who survived at least 1 year following delivery. We excluded those who had never lived in Utah, had improbable birthweight/gestational age combinations, underwent induction (except for preterm membrane rupture) or had another diagnosis likely to cause PTB.
Exposed women had ≥1 spontaneous PTB between 20 weeks and 37 weeks. Women with >1 spontaneous PTB were included only once. Unexposed women had all deliveries at or beyond 38 weeks. Exposed women were matched to unexposed women by birth year, infant sex, maternal age group and infant birth order. Included women were followed up to 39 years after index delivery.
Overall and cause-specific mortality risks were compared using Cox regression.
We included 29 048 exposed and 57 992 matched unexposed women. There were 3551 deaths among exposed (12.2%) and 6013 deaths among unexposed women (10.4%). Spontaneous PTB was associated with all-cause mortality (adjusted hazard ratio [aHR] 1.26, 95% confidence interval [CI] 1.21-1.31), death from neoplasms (aHR 1.10, 95% CI 1.02-1.18), circulatory disease (aHR 1.35, 95% CI 1.25-1.46), respiratory disease (aHR 1.73, 95% CI 1.46-2.06), digestive disease (aHR 1.33, 95% CI 1.12-1.58), genito-urinary disease (aHR 1.60, 95% CI 1.15-2.23) and external causes (aHR 1.39, 95% CI 1.22-1.58).
Spontaneous PTB is associated with modestly increased risks for all-cause and some cause-specific mortality.
确定自发性早产（PTB）妇女是否存在长期死亡风险增加的情况。
回顾性队列研究。
1939 年至 1977 年间犹他州的分娩。
我们纳入了单胎活产≥20 周且分娩后至少存活 1 年的女性。排除了那些从未在犹他州居住过、出生体重/胎龄组合不真实、接受引产（除早产胎膜早破外）或有其他可能导致 PTB 的诊断的女性。
暴露组女性在 20 周至 37 周之间至少发生了 1 次自发性 PTB。如果有多次自发性 PTB，则仅纳入 1 次。无暴露组的所有分娩均在 38 周或以上。暴露组女性通过分娩年份、婴儿性别、产妇年龄组和婴儿出生顺序与无暴露组女性相匹配。纳入的女性在指数分娩后随访 39 年。
使用 Cox 回归比较总体和病因特异性死亡风险。
我们纳入了 29048 名暴露组和 57992 名匹配的无暴露组女性。暴露组中有 3551 例死亡（12.2%），无暴露组中有 6013 例死亡（10.4%）。自发性 PTB 与全因死亡率相关（调整后的危险比[HR] 1.26，95%置信区间[CI] 1.21-1.31）、肿瘤死亡（HR 1.10，95% CI 1.02-1.18）、循环系统疾病死亡（HR 1.35，95% CI 1.25-1.46）、呼吸系统疾病死亡（HR 1.73，95% CI 1.46-2.06）、消化系统疾病死亡（HR 1.33，95% CI 1.12-1.58）、生殖泌尿系统疾病死亡（HR 1.60，95% CI 1.15-2.23）和外部原因死亡（HR 1.39，95% CI 1.22-1.58）。
自发性 PTB 与全因和某些病因特异性死亡率的适度增加相关。
