Planned Birth Before 39 Weeks and Child Development: A Population-Based Study
Planned Birth Before 39 Weeks and Child Development: A Population-Based Study
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DOI：
10.1542/peds.2016-2002
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发表时间：
2016-12-01
期刊：
影响因子：
8
通讯作者：
Nassar, Natasha
中科院分区：
文献类型：
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作者：
Bentley, Jason P.;Roberts, Christine L.;Nassar, Natasha
目的：研究胎龄和出生方式与早期儿童抽象development.METHODS：人口为基础的记录联动队列研究进行了153 730活产婴儿>= 32周的妊娠与发展评估学龄，在澳大利亚新南威尔士州，2002年至2007年。儿童在5个领域进行评估：身体健康和福祉，语言和认知，社会能力，情感成熟度，以及一般知识和沟通。在国家领域得分最低的10%的儿童被认为是发育脆弱的，而发育脆弱的儿童>= 2个领域被归类为发育高风险（DHR），这是主要结果。稳健的多变量泊松模型被用来获得个别和合并的调整相对危险度（aRRs）的胎龄和出生方式为DHR children.RESULTS：总体而言，9.6%的儿童是DHR。的aRR（95%置信区间）随着胎龄的减少而增加（参照：40周）; 32至33周1.25（1.08-1.44），34至36周（1.18-1.34），37周（1.10-1.25），38周（1.01-1.10），39周0.98（0.94-1.02），≥ 41周0.99（0.94-1.03），引产或产前剖宫产（计划生育，指自然分娩后阴道分娩）为1.07（1.04-1.11）。37周和38周时计划生育的综合aRR分别为1.26（1.18-1.34）和1.13（1.08-1.19）。结论：计划生育早期（< 39周）与学龄期儿童发育不良的风险增加相关。计划生育的时间是可以改变的，需要制定战略，为更明智的决策提供信息，以确保最佳的儿童健康和发展。
OBJECTIVE: To investigate the association of gestational age and mode of birth with early child abstract development.METHODS: Population-based record linkage cohort study was conducted among 153 730 live-born infants of >= 32 weeks' gestation with developmental assessments at school age, in New South Wales, Australia, 2002 to 2007. Children were assessed in 5 domains: physical health and well-being, language and cognition, social competence, emotional maturity, and general knowledge and communication. Children scoring in the bottom 10% of national domains were considered developmentally vulnerable, and children developmentally vulnerable for >= 2 domains were classified as developmentally high risk (DHR), the primary outcome. Robust multivariable Poisson models were used to obtain individual and combined adjusted relative risks (aRRs) of gestational age and mode of birth for DHR children.RESULTS: Overall, 9.6% of children were DHR. The aRR (95% confidence interval) of being DHR increased with decreasing gestational age (referent: 40 weeks); 32 to 33 weeks 1.25 (1.08-1.44), 34 to 36 weeks 1.26 (1.18-1.34), 37 weeks 1.17 (1.10-1.25), 38 weeks 1.06 (1.01-1.10), 39 weeks 0.98 (0.94-1.02), >= 41 weeks 0.99 (0.94-1.03), and for labor induction or prelabor cesarean delivery (planned birth; referent: vaginal birth after spontaneous labor), 1.07 (1.04-1.11). The combined aRR for planned birth was 1.26 (1.18-1.34) at 37 weeks and 1.13 (1.08-1.19) at 38 weeks.CONCLUSIONS: Early (at < 39 weeks) planned birth is associated with an elevated risk of poor child development at school age. The timing of planned birth is modifiable, and strategies to inform more judicious decision-making are needed to ensure optimal child health and development.