一胎足月并发症增加二胎早产风险 作者： 发布时间：/4/30 21:41:34 挪威卑尔根大学Liv G Kvalvik研究团队分析了一胎足月并发症和二胎早产风险之间的关联。该研究成果发表在4月29日出版的《英国医学杂志》上。
为了探讨首次足月分娩的条件和结果是否可预测早产，1999-，研究组依据挪威医疗出生登记处进行了一项基于人口的前瞻性登记研究。参与者为1999-生二胎的302192名女性。主要结局是一胎足月产后有妊娠并发症（先兆子痫、胎盘早剥、死产、新生儿死亡、小于胎龄儿）的早产（ 37孕周）相对风险。
一胎足月有五种并发症之一的女性在下一次妊娠中早产风险大大增加。在第二次妊娠中，无足月并发症女性早产的绝对风险为3.1%，足月先兆子痫为6.1%，足月胎盘早剥为7.3%，足月死产为13.1%，足月新生儿死亡为10.0%，足月小于胎龄儿为6.7%。
足月先兆子痫后未经校正的早产相对风险为2.0，足月胎盘早剥为2.3，足月死产为4.2，足月新生儿死亡为3.2，足月小于胎龄儿为2.2。平均而言，初次妊娠中合并一种足月并发症的早产风险增加2.0倍，合并两种或更多并发症的早产风险则增加3.5倍。
在排除第二次妊娠中特定并发症的复发后，这种关联仍然存在。足月并发症和早产之间的联系也可从相反方向来看：第一次妊娠的早产亦可预示第二次妊娠的足月分娩并发症。
总之，第一胎足月妊娠中发生子痫前期、胎盘早剥、死产、新生儿死亡或小于胎龄儿等并发症，二胎早产风险大大增加。足月并发症似乎与早产有着相同的重要潜在原因，早产从初次怀孕到二次怀孕会一直持续，这可能与母亲易患胎盘功能障碍有关。
附：英文原文
Title: Term complications and subsequent risk of preterm birth: registry based study
Author: Liv G Kvalvik, Allen J Wilcox, Rolv Skjrven, Truls stbye, Quaker E Harmon
Issue Volume: /04/29
Abstract: Abstract
Objective To explore conditions and outcomes of a first delivery at term that might predict later preterm birth.
Design Population based, prospective register based study.
Setting Medical Birth Registry of Norway, 1999-.
Participants 302192 women giving birth (live or stillbirth) to a second singleton child between 1999 and .
Main outcome measures Main outcome was the relative risk of preterm delivery ( 37 gestational weeks) in the birth after a term first birth with pregnancy complications: pre-eclampsia, placental abruption, stillbirth, neonatal death, and small for gestational age.
Results Women with any of the five complications at term showed a substantially increased risk of preterm delivery in the next pregnancy. The absolute risks for preterm delivery in a second pregnancy were 3.1% with none of the five term complications (8202/265043), 6.1% after term pre-eclampsia (688/11225), 7.3% after term placental abruption (41/562), 13.1% after term stillbirth (72/551), 10.0% after term neonatal death (22/219), and 6.7% after term small for gestational age (463/6939). The unadjusted relative risk for preterm birth after term pre-eclampsia was 2.0 (95% confidence interval 1.8 to 2.1), after term placental abruption was 2.3 (1.7 to 3.1), after term stillbirth was 4.2 (3.4 to 5.2), after term neonatal death was 3.2 (2.2 to 4.8), and after term small for gestational age was 2.2 (2.0 to 2.4). On average, the risk of preterm birth was increased 2.0-fold (1.9-fold to 2.1-fold) with one term complication in the first pregnancy, and 3.5-fold (2.9-fold to 4.2-fold) with two or more complications. The associations persisted after excluding recurrence of the specific complication in the second pregnancy. These links between term complications and preterm delivery were also seen in the reverse direction: preterm birth in the first pregnancy predicted complications in second pregnancies delivered at term.
Conclusions Pre-eclampsia, placental abruption, stillbirth, neonatal death, or small for gestational age experienced in a first term pregnancy are associated with a substantially increased risk of subsequent preterm delivery. Term complications seem to share important underlying causes with preterm delivery that persist from pregnancy to pregnancy, perhaps related to a mother s predisposition to disorders of placental function.
DOI: 10.1136/bmj.m1007
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期刊信息
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：27.604
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