Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta.
Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta.
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DOI：
10.1038/gim.2015.131
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发表时间：
2016-06
期刊：
影响因子：
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通讯作者：
Nagamani SC
中科院分区：
文献类型：
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作者：
Bellur S;Jain M;Cuthbertson D;Krakow D;Shapiro JR;Steiner RD;Smith PA;Bober MB;Hart T;Krischer J;Mullins M;Byers PH;Pepin M;Durigova M;Glorieux FH;Rauch F;Sutton VR;Lee B;Members of the BBD Consortium;Nagamani SC
成骨不全（OI）易发生复发性骨折。中度至重度的OI表现为产前骨折，对胎儿最安全的分娩方式尚不清楚。我们对OI相关临床研究中心迄今为止招募的最大OI患者队列（n=540）进行了系统分析。比较了I型、III型和IV型OI患者自我报告的出生时骨折率。采用后向消除逻辑回归模型构建进行多变量分析，以评估多个协变量（包括分娩方式）对妊娠相关结局的影响。当考虑到其他协变量时，无论是阴道分娩还是剖宫产（CS），出生时骨折率没有差异。无论分娩方式如何，出生体重增加都会增加骨折的风险。子宫内骨折、母亲OI史和臀位是选择CS分娩的强预测因素。我们的研究是分析各种因素对OI中出生时骨折率影响的最大研究，表明CS分娩与骨折率降低无关。由于该队列中的骨折数据是自我报告的，这些结果表明CS仅适用于其他母体或胎儿适应症，而不是仅用于预防OI中的骨折。
Osteogenesis imperfecta (OI) predisposes to recurrent fractures. The moderate-to-severe forms of OI present with antenatal fractures and the mode of delivery that would be safest for the fetus is not known. We conducted systematic analyses on the largest cohort of individuals (n=540) with OI enrolled to-date in the OI Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared in individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates including method of delivery on fracture-related outcomes. When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean section (CS). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CS for delivery. Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI shows that delivery by CS is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CS should be performed only for other maternal or fetal indications, but not for the sole purpose of fracture prevention in OI.