Gestational age-dependent risk factors for preterm birth: associations with maternal education and age early in gestation
Gestational age-dependent risk factors for preterm birth: associations with maternal education and age early in gestation
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DOI：
10.1016/j.ejogrb.2014.02.035
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发表时间：
2014-05-01
影响因子：
2.6
通讯作者：
Lo, Ernest
中科院分区：
文献类型：
--
作者：
Auger, Nathalie;Abrahamowicz, Michal;Lo, Ernest
目的：37周前早产(PTB)可发生在广泛的胎龄范围内，但很少有研究评估危险因素与PTB之间的关系是否随孕期的不同而变化。我们试图评估两个主要危险因素(母亲教育程度和年龄)和肺结核之间的关系是否取决于分娩时的孕龄。研究设计：我们使用2001-2005年间加拿大魁北克省223,756名单胎活产婴儿的回顾队列，在时间到事件分析中估计了肺结核对教育和年龄的危险比。在COX比例风险模型中，使用线性和非线性时间交互作用项，对母亲的特征进行了调整。结果：在妊娠早期，母亲受教育程度较低(与较高)和年龄较大(与较年轻)的相关性逐渐增强，因此母亲受教育程度与年龄之间的关系在整个妊娠过程中不是恒定的。结论：在妊娠早期，母亲受教育程度较低、年龄较大等危险因素与肺结核的相关性可能更强。当目标是评估低胎龄的相关性，并避免在妊娠早期隐蔽或有偏见的相关性时，捕捉到肺结核的时间依赖性的模型可能是有用的。(C)2014爱思唯尔爱尔兰有限公司。保留所有权利。
Objectives: Preterm birth (PTB) before 37 weeks can occur over a wide range of gestational ages, but few studies have assessed if associations between risk factors and PTB vary over the duration of gestation. We sought to evaluate if associations between two major risk factors (maternal education and age) and PTB depend on gestational age at delivery.Study design: We estimated hazard ratios of PTB for education and age in a time-to-event analysis using a retrospective cohort of 223,756 live singleton births from the province of Quebec, Canada for the years 2001-2005. Differences in hazards of maternal education and age with PTB were assessed over gestational age in a Cox proportional hazards model using linear and nonlinear time interaction terms, adjusting for maternal characteristics.Results: Associations of PTB with lower (vs. higher) education and older (vs. younger) age strengthened progressively at earlier gestational ages, such that the risk of PTB for maternal education and age was not constant over the course of gestation.Conclusions: Associations of PTB with risk factors such as maternal low education and older age may be stronger early in gestation. Models that capture the time-dependent nature of PTB may be useful when the goal is to assess associations at low gestational ages, and to avoid masked or biased associations early in gestation. (C) 2014 Elsevier Ireland Ltd. All rights reserved.