Preeclampsia, and preterm birth subtypes in Nova Scotia, 1986 to 1992
Preeclampsia, and preterm birth subtypes in Nova Scotia, 1986 to 1992
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DOI：
10.1055/s-2007-994090
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发表时间：
1997-01-01
影响因子：
2
通讯作者：
Bowes, WA
中科院分区：
文献类型：
--
作者：
Ananth, CV;Savitz, DA;Bowes, WA
本研究的目的是评估先兆子痫对早产的影响，检查这种关联是否在由胎龄和促发事件定义的早产亚型之间存在差异。利用新斯科舍省Atlee围产期数据库，对1986年至1992年期间加拿大新斯科舍省59，851名分娩单胎活产的妇女（共导致78，086例妊娠）进行了一项以人群为基础的轻度和重度先兆子痫与早产亚型之间关系的纵向研究。极早产（< 33周妊娠）和中度早产（33-36周妊娠）分娩进一步分类为由于（1）胎膜破裂，（2）医疗干预和（3）自然分娩（胎膜破裂前）。排除多胞胎后，轻度和重度先兆子痫分别发生在8.7%和1.7%的妊娠中。在基于广义估计方程的多变量logistic回归校正混杂因素后，重度子痫前期与由于医疗干预导致的极早产风险（RR = 80.8，95%CI：54.2-120.6）和中度早产风险（RR = 41.8，95%CI：34.0-51.4）密切相关。在合并轻度先兆子痫的妊娠中，由于医疗干预导致的极早产（KR = 2.1，95% CI：1.1-4.0）和中度早产（RR = 2.2，95% CI：1.7-2.9）风险升高不太明显。由于胎膜破裂导致的极早产非常罕见，无法检查，但由于胎膜破裂导致的中度早产与先兆子痫无关。先兆子痫与自然分娩引起的中度早产风险增加相关（RR = 1.9，95%CI：1.3-2.8），但与极早产风险无关（KR = 1.0，95%CI：0.7-1.2）。在先兆子痫和早产之间的关联中观察到了实质性的变异性，其与由胎龄和途径定义的亚型有关，高血压和医学诱导的早产之间存在强烈的关联。结果表明，需要将早产分为亚类，以正确评估先兆子痫和早产之间的关联，并采取干预措施减少先兆子痫的不良影响。
The goal of this study was to evaluate the influence of preeclampsia on preterm delivery, examining whether the association varied among preterm birth subtypes defined by gestational age and precipitating events. A population-based, longitudinal study of the association between mild and severe preeclampsia and preterm birth subtypes was conducted among 59,851 women (resulting in a total of 78,086 pregnancies) delivering singleton live births in the province of Nova Scotia, Canada between 1986 and 1992, utilizing the Nova Scotia Atlee perinatal database. Very preterm (< 33 weeks' gestation) and moderately preterm (33-36 weeks' gestation) births were further classified as occurring due to (1) membrane rupture, (2) medical intervention, and (3) spontaneous onset of labor (before membrane rupture). Mild and severe preeclampsia occurred in 8.7 and 1.7% of pregnancies, respectively, after exclusions of multiple births. After adjustment for confounders by multivariable logistic regression based on the generalized estimating equations, severe preeclampsia was strongly associated with the risk of very preterm birth (RR = 80.8, 95% CI: 54.2-120.6), and moderately preterm birth (RR = 41.8, 95% CI: 34.0-51.4) due to medical intervention. A less dramatically elevated risk of very preterm (KR = 2.1, 95% CI: 1.1-4.0) and moderately preterm (RR = 2.2, 95% CI: 1.7-2.9) birth due to medical intervention was apparent among pregnancies complicated by mild preeclampsia. Very preterm births due to membrane rupture were too rare to examine, but moderately preterm births due to membrane rupture were not associated with preeclampsia. Preeclampsia was associated with an increase in the risk of moderately preterm births due to spontaneous labor (RR = 1.9, 95% CI: 1.3-2.8), but not very preterm births (KR = 1.0, 95% CI: 0.7-1.2). Substantial variability was observed in the association between preeclampsia and preterm birth in relation to the subtypes defined by gestational age and pathway, with strong associations between hypertension and medically induced preterm births. The results indicate a need to separate preterm births into subcategories to properly evaluate the association between preeclampsia and preterm births and interventions to reduce the adverse effects of preeclampsia.