Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth.
Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth.
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DOI：
10.1097/ede.0000000000000213
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发表时间：
2015-01
期刊：
影响因子：
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通讯作者：
Laughon SK
中科院分区：
文献类型：
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作者：
Mendola P;Mumford SL;Männistö TI;Holston A;Reddy UM;Laughon SK
先兆子痫的特点是血管生成因子的改变，可能增加新生儿发病率独立早产。我们在安全分娩联盟（2002-2008）的200,103例血压正常和10,507例先兆子痫单胎妊娠中，评估了先兆子痫对新生儿结局的控制性直接影响，与早产无关。具有稳定逆概率权重的边缘结构模型解释了从先兆子痫到早产再到新生儿结局的途径中的潜在混杂因素，包括与先兆子痫状态相关的中介-结局混杂因素，如剖宫产。对所有婴儿进行足月分娩的假设干预，评估先兆子痫对围产期死亡率、小于胎龄儿（SGA）、新生儿重症监护室（NICU）入院、呼吸窘迫综合征、新生儿短暂性呼吸急促、贫血、呼吸暂停、窒息、脑室或脑室内出血和心肌病的控制性直接影响。当分娩时间设定为≥37周时，先兆子痫增加了围产儿死亡率的几率（比值比= 2.2 [95%置信区间= 1.1-4.5]，SGA =（1.9 [1.8-2.1]），NICU入院（1.9 [1.7-2.1]），呼吸窘迫综合征（2.8 [2.0-3.7]）、新生儿一过性呼吸急促（1.6 [1.3-1.9]）、呼吸暂停（2.2 [1.6-3.1]）、窒息（2.7 [1.5-4.9]）和脑室或脑室内出血（3.2 [1.4-7.7]）。未观察到足月子痫前期对贫血或心肌病的直接影响。我们的研究结果在中度混杂因素的存在下显得稳健，并且仅限于重度先兆子痫也得到了类似的结果。先兆子痫与新生儿不良结局直接相关，而不仅仅是早产引起的发病率。虽然严重的新生儿结局在孕龄后期不太常见，但边缘结构模型表明，即使有可能在足月分娩所有婴儿，先兆子痫也会增加新生儿风险。
Preeclampsia is characterized by alterations in angiogenic factors that may increase neonatal morbidity independent of preterm birth. We estimated the controlled direct effect of preeclampsia on neonatal outcomes independent of preterm birth among 200,103 normotensive and 10,507 preeclamptic singleton pregnancies in the Consortium on Safe Labor (2002–2008). Marginal structural models with stabilized inverse probability weights accounted for potential confounders in the pathway from preeclampsia to preterm birth to neonatal outcomes, including mediator-outcome confounders related to preeclampsia status, such as cesarean delivery. Controlled direct effects of preeclampsia on perinatal mortality, small for gestational age (SGA), neonatal intensive care unit (NICU) admission, respiratory distress syndrome, transient tachypnea of the newborn, anemia, apnea, asphyxia, peri- or intraventricular hemorrhage, and cardiomyopathy were estimated for the hypothesized intervention of term delivery for all infants. When delivery was set at ≥37 weeks, preeclampsia increased the odds of perinatal mortality (odds ratio = 2.2 [95% confidence interval = 1.1–4.5], SGA = (1.9 [1.8–2.1]), NICU admission (1.9 [1.7–2.1]), respiratory distress syndrome (2.8 [2.0–3.7], transient tachypnea of the newborn (1.6 [1.3–1.9]), apnea (2.2 [1.6–3.1]), asphyxia (2.7 [1.5–4.9]), and peri- or intraventricular hemorrhage (3.2 [1.4–7.7]). No direct effect of preeclampsia at term was observed for anemia or cardiomyopathy. Our results appear robust in the presence of moderate confounding, and restriction to severe preeclampsia yielded similar findings. Preeclampsia was directly associated with adverse neonatal outcomes beyond morbidity mediated by preterm birth. Although severe neonatal outcomes were less common at later gestational ages, marginal structural models suggested elevated neonatal risk due to preeclampsia even if it was possible to deliver all infants at term.