Maternal, fetal, and placental conditions associated with medically indicated late preterm and early term delivery: a retrospective study
Maternal, fetal, and placental conditions associated with medically indicated late preterm and early term delivery: a retrospective study
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DOI：
10.1111/1471-0528.14120
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发表时间：
2016-04-01
影响因子：
5.8
通讯作者：
Campbell, M. K.
中科院分区：
文献类型：
--
作者：
Brown, H. K.;Speechley, K. N.;Campbell, M. K.
目的我们的目标是：（1）检查早产的母体、胎儿和胎盘表型与早产晚期和足月早期医学上指示的单胎早期分娩之间的关联； (2) 确定与这些早期分娩相关的特定母体、胎儿和胎盘状况。设计回顾性研究。设置加拿大安大略省伦敦市和米德尔塞克斯县。对伦敦和米德尔塞克斯妇女妊娠 34-41 周的单例活产进行采样。方法我们从全市围产期数据库中获得数据（2002-2011 年；n=25699）。我们使用多项 Logistic 回归进行多变量分析。主要结果测量结果是医学上指示的晚期早产（妊娠 34-36 周）和早期足月（妊娠 37-38 周）分娩与足月分娩（妊娠 39-41 周）的发生率。结果在控制混杂因素后，所有表型都与医学上指示的晚期早产和早期足月分娩的几率增加相关。在母亲表型中，慢性母亲健康状况与医学上指示的早产的几率增加相关（例如，对于胃肠道疾病，调整后的比值比，aOR1.72，95%CI 1.47-2.00；对于贫血，aOR1.40，95%CI 1.20-1.63），但与晚期早产无关。结论医学上指示的早期分娩接近足月的病因学是异质的。关联模式表明，晚期早产和早期足月表型的基础条件略有不同，慢性孕产妇健康状况与早产有关，但与晚期早产无关。这些结果对于预防早产以及识别早产者中的高危人群具有重要意义。
ObjectiveOur objectives were: (1) to examine the association between maternal, fetal, and placental phenotypes of preterm delivery and medically indicated early delivery of singletons during the late preterm and early term periods; and (2) to identify the specific maternal, fetal, and placental conditions associated with these early deliveries.DesignRetrospective study.SettingCity of London and Middlesex County, Ontario, Canada.SampleSingleton live deliveries, at 34-41weeks of gestation to women in London and Middlesex.MethodsWe obtained data from a city-wide perinatal database (2002-2011; n=25699). We used multinomial logistic regression for multivariable analyses.Main outcome measureThe outcome was the occurrence of medically indicated late preterm (34-36weeks of gestation) and early term (37-38weeks of gestation) delivery, versus delivery at full term (39-41weeks of gestation).ResultsAfter controlling for confounding factors, all phenotypes were associated with increased odds of medically indicated late preterm and early term delivery. Within the maternal phenotype, chronic maternal medical conditions were associated with increased odds of medically indicated early term delivery (e.g. for gastrointestinal disease, adjusted odds ratio, aOR1.72, 95%CI 1.47-2.00; for anaemia, aOR1.40, 95%CI 1.20-1.63), but not late preterm delivery.ConclusionsThe aetiology of medically indicated early delivery close to full term is heterogeneous. Patterns of associations suggest slightly different conditions underlying the late preterm and early term phenotypes, with chronic maternal medical conditions being associated with early term delivery but not with late preterm delivery. These results have implications for the prevention of early delivery as well as the identification of high-risk groups among those born early.