Estimating recurrence of spontaneous preterm delivery
Estimating recurrence of spontaneous preterm delivery
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DOI：
10.1097/aog.0b013e318184181a
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发表时间：
2008-09-01
影响因子：
7.2
通讯作者：
Varner, Michael W.
中科院分区：
文献类型：
--
作者：
Esplin, Michael S.;O'Brien, Elizabeth;Varner, Michael W.
目的：采用回顾性队列研究设计，在1989年至2001年期间，在犹他州有第一胎和任何后续生育的妇女中，确定与自发性早产相关的因素，并估计其在第二胎至第四胎中复发的风险。对犹他州的出生记录进行了审查，以确定1989年至2001年期间有第一次活产和至少一次后续活产的妇女。自发性早产的复发风险计算为第一至第四胎。采用多元回归分析方法，对早产儿结局的再发风险进行评估。计算早期和晚期自发性早产的复发风险。复发率也被评估为归因于既往自发性早产的分数。使用确定的因素，样本被划分和模型估计的一个子集的出生（1989年至1999年），其预测值进行了测试，其余的births（2000年至2001年）。结果：妇女谁经历了自发性早产前34周的妊娠在其第一次或第二次活产复发率最高。孕34周前自然早产是早期自然早产复发的最高危险因素（相对危险度13.56，95%可信区间11.5-16.0），一般来说，相同胎龄的复发风险最高。结论：孕34周前的活产史是随后自发性早产的一个强有力的预测因子。临床风险因素模型可用于识别复发性自发性早产风险增加的妇女。
OBJECTIVE: To identify factors associated with spontaneous preterm birth and to estimate the risk of its recurrence for the second through fourth births among women in Utah who had a first and any subsequent birth between 1989 and 2001, using a retrospective cohort study design.METHODS: Utah state birth records were reviewed to identify women with a first live birth and at least one subsequent live birth from 1989 to 2001. Recurrence risks for spontaneous preterm birth were calculated for first through fourth births. Then all parties (1-12) and multiple maternal risk factors were used to estimate recurrence risks for pre-term birth outcomes by multinomial regression. Recurrence risks for early and late spontaneous preterm birth were calculated. Recurrence also was evaluated as the fraction attributable to previous spontaneous preterm birth. Using the identified factors, the sample was divided and the model was estimated for a subset of births (1989-1999); its predictive value was tested on the remaining births (2000-2001).RESULTS: Women who experienced a spontaneous preterm birth before 34 weeks of gestation in their first or second live birth had the highest rate of recurrence. Spontaneous preterm birth before 34 weeks was the highest risk factor for recurrence of early spontaneous preterm birth (relative risk 13.56, 95% confidence interval 11.5-16.0), and, in general, risks were highest for recurrences of same gestational age outcomes.CONCLUSION: A history of a live spontaneous birth before 34 weeks of gestation is a strong predictor of subsequent spontaneous preterm birth. A model of clinical risk factors may be used to identify women at increased risk for recurrent spontaneous preterm birth.