Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study.
Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study.
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出生时胎龄对3岁和5岁时健康结果的影响：基于人群的队列研究。
DOI：
10.1136/bmj.e896
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发表时间：
2012-03-01
期刊：
影响因子：
--
通讯作者：
Quigley MA
中科院分区：
文献类型：
--
作者：
Boyle EM;Poulsen G;Field DJ;Kurinczuk JJ;Wolke D;Alfirevic Z;Quigley MA
目的探讨中晚期早产(32~36周)和早产(37~38周)对晚期疾病造成的负担。设计对来自千年队列研究(MCS)的数据进行二次分析。背景：对2000至2002年间在英国出生的婴儿进行纵向研究。受试者18名 818名婴儿参加了MCS。分析出生时胎龄对3岁(n=14 273)和5岁(n=14 056)健康结局的影响。主要指标包括成长、入院、长期患病/残疾、喘息/哮喘、处方药的使用以及父母对子女健康的评价。结果一般健康、住院和长期疾病的测量结果显示，随着妊娠的减少，不良结局的风险逐渐增加，这表明早产存在“剂量-反应”效应。3岁和5岁时对疾病负担的贡献最大的是晚产/中产、早产或早产的儿童。在9个月至5岁之间至少有三次入院治疗的人群归因分数，32-36周出生的为5.7%(95%可信区间2.0%至10.0%)，37-38周出生的为7.2%(1.4%至13.6%)，而早产儿(32周)为3.8%(1.3%至6.5%)。同样，2.7%(1.1%到4.3%)、5.4%(2.4%到8.6%)和5.4%(0.7%到10.5%)的5年内限制长期疾病被归因于极早产、中晚期早产和早产。结论中晚期早产儿和早产儿的健康结局比足月儿差。其他研究应该量化这种影响在多大程度上是由母体/胎儿并发症造成的，而不是早产本身。无论早产的原因是什么，这些婴儿中的大量对公共卫生服务造成的负担比早产婴儿更大。
Objective To investigate the burden of later disease associated with moderate/late preterm (32-36 weeks) and early term (37-38 weeks) birth. Design Secondary analysis of data from the Millennium Cohort Study (MCS). Setting Longitudinal study of infants born in the United Kingdom between 2000 and 2002. Participants 18 818 infants participated in the MCS. Effects of gestational age at birth on health outcomes at 3 (n=14 273) and 5 years (n=14 056) of age were analysed. Main outcome measures Growth, hospital admissions, longstanding illness/disability, wheezing/asthma, use of prescribed drugs, and parental rating of their children’s health. Results Measures of general health, hospital admissions, and longstanding illness showed a gradient of increasing risk of poorer outcome with decreasing gestation, suggesting a “dose-response” effect of prematurity. The greatest contribution to disease burden at 3 and 5 years was in children born late/moderate preterm or early term. Population attributable fractions for having at least three hospital admissions between 9 months and 5 years were 5.7% (95% confidence interval 2.0% to 10.0%) for birth at 32-36 weeks and 7.2% (1.4% to 13.6%) for birth at 37-38 weeks, compared with 3.8% (1.3% to 6.5%) for children born very preterm (<32 weeks). Similarly, 2.7% (1.1% to 4.3%), 5.4% (2.4% to 8.6%), and 5.4% (0.7% to 10.5%) of limiting longstanding illness at 5 years were attributed to very preterm birth, moderate/late preterm birth, and early term birth. Conclusions These results suggest that health outcomes of moderate/late preterm and early term babies are worse than those of full term babies. Additional research should quantify how much of the effect is due to maternal/fetal complications rather than prematurity itself. Irrespective of the reason for preterm birth, large numbers of these babies present a greater burden on public health services than very preterm babies.
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影响因子：
5.1
作者：
Chyi, Lisa J.;Lee, Henry C.;Sutcliffe, Trenna L.
通讯作者：
Sutcliffe, Trenna L.
影响因子：
8
作者：
Talge, Nicole M.;Holzman, Claudia;Breslau, Naomi
通讯作者：
Breslau, Naomi
影响因子：
15.8
作者：
MacKay DF;Smith GC;Dobbie R;Pell JP
通讯作者：
Pell JP
影响因子：
3.4
作者：
Escobar, GJ;Clark, RH;Greene, JD
通讯作者：
Greene, JD
影响因子：
5.1
作者：
Petrini, Joann R.;Dias, Todd;Escobar, Gabriel J.
通讯作者：
Escobar, Gabriel J.