母体特征和中期妊娠血清生物标志物与早产亚型的风险因素。
Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth.
机构信息
Genetic Disease Screening Program, California Department of Public Health, Richmond, CA, USA.
Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco School of Medicine, San Francisco, CA, USA.
出版信息
BJOG. 2015 Oct;122(11):1484-93. doi: 10.1111/1471-0528.13495. Epub 2015 Jun 26.
OBJECTIVE
To examine the relationship between maternal characteristics, serum biomarkers and preterm birth (PTB) by spontaneous and medically indicated subtypes.
DESIGN
Population-based cohort.
SETTING
California, United States of America.
POPULATION
From a total population of 1 004 039 live singleton births in 2009 and 2010, 841 665 pregnancies with linked birth certificate and hospital discharge records were included.
METHODS
Characteristics were compared for term and preterm deliveries by PTB subtype using logistic regression and odds ratios adjusted for maternal characteristics and obstetric factors present in final stepwise models and 95% confidence intervals. First-trimester and second-trimester serum marker levels were analysed in a subset of 125 202 pregnancies with available first-trimester and second-trimester serum biomarker results.
MAIN OUTCOME MEASURE
PTB by subtype.
RESULTS
In fully adjusted models, ten characteristics and three serum biomarkers were associated with increased risk in each PTB subtype (Black race/ethnicity, pre-existing hypertension with and without pre-eclampsia, gestational hypertension with pre-eclampsia, pre-existing diabetes, anaemia, previous PTB, one or two or more previous caesarean section(s), interpregnancy interval ≥ 60 months, low first-trimester pregnancy-associated plasma protein A, high second-trimester α-fetoprotein, and high second-trimester dimeric inhibin A). These risks occurred in 51.6-86.2% of all pregnancies ending in PTB depending on subtype. The highest risk observed was for medically indicated PTB <32 weeks in women with pre-existing hypertension and pre-eclampsia (adjusted odds ratio 89.7, 95% CI 27.3-111.2).
CONCLUSIONS
Our findings suggest a shared aetiology across PTB subtypes. These commonalities point to targets for further study and exploration of risk reduction strategies.
TWEETABLE ABSTRACT
Findings suggest a shared aetiology across preterm birth subtypes. Patterns may inform risk reduction efforts.
目的
通过自发性和医学指征性早产（PTB）亚类研究母体特征、血清生物标志物与早产的关系。
设计
基于人群的队列研究。
地点
美国加利福尼亚州。
人群
在 2009 年和 2010 年的 1004039 例活产单胎中，纳入了 841665 例具有链接出生证明和医院出院记录的妊娠。
方法
采用逻辑回归和优势比比较了各 PTB 亚类足月分娩和早产的特征，并在最终逐步模型中调整了母体特征和产科因素，置信区间为 95%。在有可用的孕早期和孕中期血清生物标志物结果的 125202 例妊娠亚组中分析了孕早期和孕中期血清标志物水平。
主要观察指标
各亚类的早产。
结果
在完全调整的模型中，10 个特征和 3 个血清生物标志物与每种 PTB 亚类的风险增加相关（黑人种族/民族、有或无先兆子痫的既往高血压、伴有先兆子痫的妊娠期高血压、既往糖尿病、贫血、既往早产、一次或两次或更多次剖宫产、孕中期间隔≥60 个月、孕早期妊娠相关血浆蛋白 A 低、孕中期甲胎蛋白高、孕中期二聚体抑制素 A 高）。根据亚类的不同，所有早产妊娠中，这些风险发生在 51.6%-86.2%。在患有既往高血压和先兆子痫的女性中，观察到的风险最高的是医学指征性 PTB<32 周（调整后的优势比为 89.7，95%CI 27.3-111.2）。
结论
我们的研究结果表明各 PTB 亚类存在共同的病因。这些共性为进一步研究和探索降低风险的策略指明了方向。
推文摘要
研究结果表明各早产亚类存在共同的病因。这些模式可能为降低风险的努力提供信息。
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