The contribution of birth defects to preterm birth and low birth weight
The contribution of birth defects to preterm birth and low birth weight
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DOI：
10.1097/01.aog.0000275264.78506.63
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发表时间：
2007-08-01
影响因子：
7.2
通讯作者：
D'Alton, Mary E.
中科院分区：
文献类型：
--
作者：
Dolan, Siobhan M.;Gross, Susan J.;D'Alton, Mary E.
目的：探讨出生缺陷对早产儿和低出生体重儿的影响。方法：对一项大型前瞻性多中心试验，即妊娠早期和中期风险评估（FASTER）试验的数据进行分析。所有妊娠24周以上的活产婴儿，包括结局和混杂因素的数据，分为两组：1)染色体或结构异常（出生缺陷）组和2)染色体或解剖结构未检测到异常的组。倾向评分用于平衡各组，考虑混杂因素，并在评估出生缺陷对结果的影响时减少大量潜在混杂因素的偏倚。采用多元logistic回归分析。结果：有先天缺陷的单胎活产婴儿在37周前早产的可能性高出2.7倍。（95%可信区间[Cl] 2.3-3.2）， 34周前早产的可能性为7.0倍（95% Cl 5.5-8.9）， 32周前早产的可能性为11.5倍（95% Cl 8.7-15.2）。有出生缺陷的单胎活产婴儿出生体重低于2500克（95% Cl 3.0-4.3）的可能性是低出生体重的3.6倍，出生体重低于1500克（95% Cl 8.5-15.1）的可能性是极低出生体重的11.3倍。结论：采用多变量回归分析中的倾向评分调整方法，控制共同危险因素和妊娠并发症等多重混杂因素后，出生缺陷与早产和低出生体重相关。风险因素对围产期结局的独立影响，如早产和低出生体重，通常由许多混杂因素复杂化，可能受益于该方法的应用，该方法可用于最大限度地减少偏差和解释混杂因素。此外，这表明旨在预防出生缺陷的临床和公共卫生干预措施可能在预防早产和低出生体重方面有额外的好处。
Objective: To assess the impact of birth defects on preterm birth and low birth weight.Methods: Data from a large, prospective multi-center trial, the First and Second Trimester Evaluation of Risk (FASTER) Trial, were examined. All live births at more than 24 weeks of gestation with data on outcome and confounders were divided into two comparison groups: 1) those with a chromosomal or structural abnormality (birth defect) and 2) those with no abnormality detected in chromosomes or anatomy. Propensity scores were used to balance the groups, account for confounding, and reduce the bias of a large number of potential confounding factors in the assessment of the impact of a birth defect on outcome. Multiple logistic regression analysis was applied.Results: A singleton liveborn infant with a birth defect was 2.7 times more likely to be delivered preterm before 37 weeks. of gestation (95% confidence interval [Cl] 2.3-3.2), 7.0 times more likely to be delivered preterm before 34 weeks (95% Cl 5.5-8.9), and 11.5 times more likely to be delivered very preterm before 32 weeks (95% Cl 8.7-15.2). A singleton liveborn with a birth defect was 3.6 times more likely to have low birth weight at less than 2,500 g (95% Cl 3.0-4.3) and 11.3 times more likely to be very low birth weight at less than 1,500 g (95% Cl 8.5-15.1).Conclusion: Birth defects are associated with preterm birth and low birth weight after controlling for multiple confounding factors, including shared risk factors and pregnancy complications, using propensity scoring adjustment in multivariable regression analysis. The independent effects of risk factors on perinatal outcomes such as preterm birth and low birth weight, usually complicated by numerous confounding factors, may benefit from the application of this methodology, which can be used to minimize bias and account for confounding. Furthermore, this suggests that clinical and public health interventions aimed at preventing birth defects may have added benefits in preventing preterm birth and low birth weight.