Demographic and Behavioral Predictors of Severe Fetomaternal Hemorrhage: A Case-Control Study.
Demographic and Behavioral Predictors of Severe Fetomaternal Hemorrhage: A Case-Control Study.
复制标题
严重胎儿母体出血的人口统计学和行为预测因素：病例对照研究。
DOI：
10.1159/000442082
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发表时间：
2016
期刊：
影响因子：
2.5
通讯作者：
Savitz,DavidA
中科院分区：
文献类型：
--
作者：
Stroustrup,Annemarie;Plafkin,Callie;Tran,Thuy-An;Savitz,DavidA
背景：胎母出血（FMH）是胎盘屏障全血移植失败的标志。FMH后的胎儿贫血与显著的发病率和死亡率相关。如果FMH是早期发现，胎儿贫血可以治疗，以尽量减少不良后果。FMH的危险因素尚不清楚，限制了为FMH提供有针对性筛查的努力。目的：确定在胎儿发病前可识别的与FMH相关的母体和/或妊娠特征。方法：这是首次发表的FMH病例对照研究。病例是从1988年至2010年期间所有住院分娩的前瞻性数据库中确定的。每个病例按出生日期和时间与4个对照相匹配，以便对广泛的临床和人口统计数据进行评估。采用Logistic回归模型评估人口统计学和临床特征与FMH诊断之间的关系。结果：共评估了23对FMH影响的母婴和92对匹配的对照。与对照组相比，病例母亲更有可能拥有私人保险，并且在怀孕期间外出工作和夜间工作。病例更有可能早产，但早产在病例中并不常见。与对照组相比，病例的种族/民族没有差异。结论：严重的FMH与新生儿显著的发病率和死亡率相关。患有FMH的妇女在怀孕期间比正常怀孕的妇女更有可能外出工作。这一发现对在高强度领域工作的孕妇进行妊娠晚期筛查具有启示意义。
Background:Fetomaternal hemorrhage (FMH) signifies failure of the placental barrier with whole blood transfer. Fetal anemia following FMH is associated with significant morbidity and mortality. If FMH is identified early, fetal anemia can be treated to minimize adverse outcomes. Risk factors for FMH are not known, limiting efforts to provide targeted screening for FMH.Objective:To identify maternal and/or pregnancy characteristics associated with FMH that are recognizable prior to fetal morbidity.Methods:This is the first published case-control study of FMH. Cases were identified from a prospectively maintained database of all hospital births between 1988 and 2010. Each case was matched to 4 controls by date and time of birth, allowing for assessment of a wide range of clinical and demographic data. Logistic regression modeling was used to assess the association between demographic and clinical characteristics and the diagnosis of FMH.Results:A total of 23 mother-baby pairs impacted by FMH and 92 matched controls were evaluated. Compared to controls, case mothers were more likely to have private insurance and to work outside the home and at night during pregnancy. Cases were more likely to be delivered preterm, but preterm labor was not more common among cases. There was no difference in race/ethnicity of cases compared to controls.Conclusions:Severe FMH is associated with significant morbidity and mortality of the affected neonate. Women with FMH were more likely to work outside the home during pregnancy than women with normal pregnancies. This finding has implications for third-trimester screening of pregnant women who work in strenuous fields.