Ariyoshi Yu, Iriyama Takayuki, Sayama Seisuke, Suzuki-Ariyoshi Eri, Yano Eriko, Matsui Haruka, Suzuki Kensuke, Hashimoto Ayako, Ichinose Mari, Toshimitsu Masatake, Seyama Takahiro, Sone Kenbun, Wada-Hiraike Osamu, Ito Atsushi, Shitara Yoshihiko, Kumasawa Keiichi, Ishiguro Akio, Kakiuchi Satsuki, Kashima Kohei, Hirota Yasushi, Takahashi Naoto, Osuga Yutaka
Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Pediatrics, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
J Obstet Gynaecol Res. 2025 May;51(5):e16315. doi: 10.1111/jog.16315.
This study aims to investigate the association between placental insufficiency and complications in extremely preterm infants in the context of ischemic placental disease (IPD), including preeclampsia, small-for-gestational-age (SGA), and placental abruption.
Infants born between 22 and 28 weeks of gestation were classified into IPD and non-IPD groups, matched 1:1 by gestational age and sex. The incidence of neonatal complications was analyzed.
Analysis included 48 infants in each group. The IPD group had a significantly lower birth weight (IPD vs. non-IPD: 679 g vs. 979 g, p < 0.001), whereas the non-IPD group was characterized by a higher prevalence of spontaneous preterm births (12% vs. 79%, p < 0.001) and a significantly higher incidence of histological chorioamnionitis (CAM) (15% vs. 50%, p < 0.001). The IPD group showed a significantly higher incidence of bronchopulmonary dysplasia (BPD) compared to the non-IPD group (85% vs. 48%, p < 0.001), with no significant differences in other complications such as intraventricular hemorrhage, retinopathy of prematurity, and necrotizing enterocolitis. Logistic regression identified IPD as a significant risk factor for BPD (odds ratio [OR] [95% confidence interval]: 9.4 [2.8-31.8], p < 0.001), along with preeclampsia (OR: 4.9 [1.3-18.3], p = 0.01) and SGA (OR: 31.9 [5.9-171], p < 0.001). CAM was not associated with BPD (OR: 0.6 [0.2-1.7], p = 0.45).
Placental insufficiency, manifesting as IPD, is strongly associated with an increased risk of BPD in extremely preterm infants.
本研究旨在探讨在缺血性胎盘疾病（IPD）背景下，胎盘功能不全与极早早产儿并发症之间的关联，IPD包括先兆子痫、小于胎龄儿（SGA）和胎盘早剥。
将妊娠22至28周出生的婴儿分为IPD组和非IPD组，根据胎龄和性别1:1匹配。分析新生儿并发症的发生率。
每组纳入48例婴儿。IPD组出生体重显著更低（IPD组与非IPD组：679g对979g，p<0.001），而非IPD组的特点是自然早产发生率更高（12%对79%，p<0.001）以及组织学绒毛膜羊膜炎（CAM）发生率显著更高（15%对50%，p<0.001）。与非IPD组相比，IPD组支气管肺发育不良（BPD）的发生率显著更高（85%对48%，p<0.001），在其他并发症如脑室内出血、早产儿视网膜病变和坏死性小肠结肠炎方面无显著差异。逻辑回归确定IPD是BPD的显著危险因素（比值比[OR][95%置信区间]：9.4[2.8 - 31.8]，p<0.001），先兆子痫（OR：4.9[1.3 - 18.3]，p = 0.01）和SGA（OR：31.9[5.9 - 171]，p<0.001）也是。CAM与BPD无关（OR：0.6[0.2 - 1.7]，p = 0.45）。
表现为IPD的胎盘功能不全与极早早产儿发生BPD的风险增加密切相关。
