Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk
Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk
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DOI：
10.1542/peds.2006-3629
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发表时间：
2008-02-01
期刊：
影响因子：
8
通讯作者：
Declercq, Eugene
中科院分区：
文献类型：
--
作者：
Shapiro-Mendoza, Carrie K.;Tomashek, Kay M.;Declercq, Eugene
目标。晚期早产儿(孕34-36周)占美国所有早产儿的近四分之三，但人们对他们的发病风险知之甚少。我们比较了晚期早产儿和足月儿(孕37-41周)，有或没有选择母亲的医疗条件，并评估了这些暴露对新生儿发病率风险的独立和联合影响。方法：我们使用了1998-2003年基于人口的马萨诸塞州出生和死亡证明数据，这些数据与马萨诸塞州怀孕到早期生活纵向数据系统中的婴儿和产妇出院记录相关联。通过计算调整后的风险比，估计与胎龄和选定的母亲医疗条件相关的新生儿发病率风险，无论是独立的还是作为联合暴露。根据出院诊断代码、住院时间和转院状态，创建了一种新的新生儿发病率衡量标准，以定义有或没有危及生命的新生儿。结果：我们最终的研究人群包括26 170名早产儿和377 638名足月儿。晚期早产儿的新生儿发病率是足月儿的7倍(22%比3%)。早于38周的每个孕周，婴儿的新生儿发病率翻了一番。与类似暴露的足月儿相比，母亲患有任何一种评估的母亲所生的晚期早产儿患新生儿发病率的风险更高。晚期早产儿特别容易发生产前出血和妊娠高血压疾病。结论：晚期早产儿和母亲的医疗状况都是新生儿发病率的独立危险因素。这两个因素加在一起，与出生时没有暴露于这些风险的足月儿相比，极大地增加了新生儿发病率的风险。
OBJECTIVES. Late-preterm infants (34-36 weeks' gestation) account for nearly three quarters of all preterm births in the United States, yet little is known about their morbidity risk. We compared late-preterm and term (37-41 weeks' gestation) infants with and without selected maternal medical conditions and assessed the independent and joint effects of these exposures on newborn morbidity risk.METHODS. We used 1998-2003, population-based, Massachusetts birth and death certificates data linked to infant and maternal hospital discharge records from the Massachusetts Pregnancy to Early Life Longitudinal data system. Newborn morbidity risks that were associated with gestational age and selected maternal medical conditions, both independently and as joint exposures, were estimated by calculating adjusted risk ratios. A new measure of newborn morbidity that was based on hospital discharge diagnostic codes, hospitalization duration, and transfer status was created to define newborns with and without life-threatening conditions. Eight selected maternal medical conditions were assessed (hypertensive disorders of pregnancy, diabetes, antepartum hemorrhage, lung disease, infection, cardiac disease, renal disease, and genital herpes) in relation to newborn morbidity.RESULTS. Our final study population included 26 170 infants born late preterm and 377 638 born at term. Late-preterm infants were 7 times more likely to have newborn morbidity than term infants (22% vs 3%). The newborn morbidity rate doubled in infants for each gestational week earlier than 38 weeks. Late-preterm infants who were born to mothers with any of the maternal conditions assessed were at higher risk for newborn morbidity compared with similarly exposed term infants. Late-preterm infants who were exposed to antepartum hemorrhage and hypertensive disorders of pregnancy were especially vulnerable.CONCLUSIONS. Late-preterm birth and, to a lesser extent, maternal medical conditions are each independent risk factors for newborn morbidity. Combined, these 2 factors greatly increased the risk for newborn morbidity compared with term infants who were born without exposure to these risks.