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产前使用糖皮质激素的患者早产可能性与诊断及混杂风险因素的关系:一项回顾性队列研究

Likelihood of Preterm Birth in Patients After Antenatal Corticosteroid Administration in Relation to Diagnosis and Confounding Risk Factors: A Retrospective Cohort Study.

作者信息

Pauluschke-Fröhlich Jan, Berger Richard, Abele Harald, Plappert Claudia F, Graf Joachim

机构信息

Department of Women's Health, University Hospital Tübingen, 72076 Tubingen, Germany.

Department of Obstetrics and Gynecology, Hospital Marienhaus, 56564 Neuwied, Germany.

出版信息

Healthcare (Basel). 2025 Jan 6;13(1):87. doi: 10.3390/healthcare13010087.

Abstract

: In the case of threatened preterm birth (PTB) before the 34th week of pregnancy, the application of antenatal corticosteroids (ACSs) for the maturation of the fetal lung is a standard procedure in perinatal medicine. Common diagnoses for ACS use in pregnancy are the preterm rupture of membranes (PPROMs), placental bleeding, premature labor, preeclampsia, oligohydramnios, amniotic infection syndrome (AIS), and cervical insufficiency. The aim of this study was to investigate whether the current diagnosis, which results in ACS, and the patient's risk factors influence the risk of PTB events. : The data of all affected women were extracted, who were hospitalized in 2016 due to a threatening PTB and administered corticosteroids in the German federal state Rhineland-Palatinate ( = 1544), so the study was conducted as a retrospective cohort trial. Frequency analyses, Friedman tests, Chi square tests, logistic regressions, Spearman correlation, and moderation analysis were performed to determine the Odds ratio (OR) for PTB in ACS patients in relation to diagnosis and risk factors. : Only 60% of all patients with PTB risk delivered prematurely, whereby patients with different diagnoses differ in terms of the PTB risk; the highest risk could be found in AIS (OR = 16.12) or preeclampsia (OR = 5.46). For prior PTB, stillbirth, or abortion, there is a moderation effect (based on the confounders), while multiple pregnancies influence the PTB risk irrespective of diagnosis (OR = 6.45). In the whole collective, the OR for PTB was 6.6 in relation to all pregnant women in Germany. : A higher risk of PTB could be found in patients with a diagnosis of AIS, preeclampsia, as well as in multiple pregnancies. Prior PTB, stillbirth, or abortion act as a relevant confounder.

摘要

对于妊娠34周前出现先兆早产(PTB)的情况,应用产前糖皮质激素(ACSs)促进胎儿肺成熟是围产医学中的标准程序。孕期使用ACSs的常见诊断包括胎膜早破(PPROMs)、胎盘出血、早产、先兆子痫、羊水过少、羊膜腔感染综合征(AIS)和宫颈机能不全。本研究的目的是调查导致使用ACSs的当前诊断以及患者的风险因素是否会影响PTB事件的风险。

提取了所有受影响女性的数据,这些女性于2016年因先兆PTB在德国莱茵兰 - 普法尔茨州住院并接受了糖皮质激素治疗(n = 1544),因此该研究作为一项回顾性队列试验进行。进行了频率分析、弗里德曼检验、卡方检验、逻辑回归、斯皮尔曼相关性分析和调节分析,以确定ACS患者中PTB相对于诊断和风险因素的优势比(OR)。

所有有PTB风险的患者中只有60%早产,不同诊断的患者在PTB风险方面存在差异;AIS(OR = 16.12)或先兆子痫(OR = 5.46)患者的风险最高。对于既往PTB、死产或流产,存在调节作用(基于混杂因素),而多胎妊娠无论诊断如何都会影响PTB风险(OR = 6.45)。在整个总体中,相对于德国所有孕妇,PTB的OR为6.6。

诊断为AIS、先兆子痫的患者以及多胎妊娠患者的PTB风险较高。既往PTB、死产或流产是相关的混杂因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8b1/11720013/36f00eb05ff6/healthcare-13-00087-g001.jpg

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