Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth.
Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth.
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DOI：
10.1111/1471-0528.13495
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发表时间：
2015-10
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影响因子：
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通讯作者：
Currier RJ
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作者：
Jelliffe-Pawlowski LL;Baer RJ;Blumenfeld YJ;Ryckman KK;O'Brodovich HM;Gould JB;Druzin ML;El-Sayed YY;Lyell DJ;Stevenson DK;Shaw GM;Currier RJ
通过自发和医学指征亚型检查母体特征、血清生物标志物和早产（PTB）之间的关系。以人口为基础的群组。美利坚合众国，加州。在2009年和2010年的1 004 039名活产单胎婴儿中，有841 665名孕妇的出生证明和出院记录相关联。使用logistic回归和优势比，根据最终逐步模型（adjOR）中的母体特征和产科因素进行调整，并采用95%置信区间（CI），比较PTB亚型的足月分娩和早产特征。在125，202例妊娠的子集中分析了早期和中期妊娠血清标志物水平，并获得了早期和中期妊娠血清标志物结果。PTB亚型。在完全校正的模型中，10个特征和3个血清生物标志物与每种PTB亚型的风险增加相关（黑人种族/民族、既存高血压伴或不伴先兆子痫、妊娠期高血压伴先兆子痫、既存糖尿病、贫血、既往PTB、既往一次或≥两次剖腹产、解释间隔≥ 60个月、妊娠早期妊娠相关血浆蛋白A较低，高中期妊娠甲胎蛋白和高中期妊娠二聚体胆红素A）。这些风险发生在51.6%至86.2%的所有妊娠终止于PTB，这取决于亚型。在既存高血压和先兆子痫的女性中，观察到的最高风险是医学指示的PTB < 32周（adjOR 89.7，27.3 - 111.2）。我们的研究结果表明PTB亚型之间存在共同的病因。这些共同点为进一步研究和探索减少风险战略指明了目标。
To examine the relationship between maternal characteristics, serum biomarkers, and preterm birth (PTB) by spontaneous and medically-indicated subtypes. Population-based cohort. California, United States of America. From a total population of 1,004,039 live singleton births in 2009 and 2010, 841,665 pregnancies with linked birth certificate and hospital discharge records were included. Characteristics were compared for term and preterm deliveries by PTB subtype using logistic regression and odds ratios adjusted for maternal characteristics and obstetric factors present in final stepwise models (adjORs) and 95% confidence intervals (CIs). First and second trimester serum marker levels were analyzed in a subset of 125,202 pregnancies with available first and second trimester serum biomarker results. PTB by subtype. In fully adjusted models, ten characteristics and three serum biomarkers were associated with increased risk in each PTB subtype (Black race/ethnicity, preexisting hypertension with and without preeclampsia, gestational hypertension with preeclampsia, preexisting diabetes, anemia, previous PTB, one or ≥ two previous cesarean section(s), interpregnancy interval ≥ 60 months, low first trimester pregnancy-associated plasma protein A, high second trimester alpha-fetoprotein, and high second trimester dimeric inhibin A). These risks occurred in 51.6 to 86.2% of all pregnancies ending in PTB depending on subtype. The highest risk observed was for medically-indicated PTB < 32 weeks in women with preexisting hypertension and preeclampsia (adjOR 89.7, 27.3 – 111.2). Our findings suggest a shared etiology across PTB subtypes. These commonalities point to targets for further study and exploration of risk reduction strategies.