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JAMA:已知的多种风险因子可预测死产风险

来源:EurekAlert 2011-12-15 13:13

12月14日,JAMA杂志上的一项研究"Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation"中,德州大学医学院加尔维斯顿分校的George R. Saade, M.D.及其在死产协作研究网络写作组的同事对死产与在怀孕伊始就可确定的风险因子之间的关系进行了检查,尤其是这些因子对存在于死产中的种族差异的影响。

文章的作者写道:“许多与死产有关的因子在怀孕的早期就需要引起注意。尽管其它的因素在怀孕的后期会变得重要,但提供产科护理的临床医生常常是在患者起初几次就诊时会花相对较多的时间向病人提供有关她们出现不良妊娠后果风险的咨询服务。”

这一多点进行的基于人口的有对照的案例研究是在2006年3月至2008年9月间在59家美国的三级护理医院及社区医院中进行的,这些医院可以接触到5个由州及县边界界定地区内的至少90%的分娩。纳入这项研究的是分娩过一个或一个以上死产胎儿的居民,以及一个代表性的只分娩活产婴儿的样本,该样本由对在不到32孕周时分娩的妇女及那些在32孕周或孕期更长时分娩的非洲裔妇女的过采样来补充。这项研究包括614个病例及1816个对照分娩案例。

研究人员发现,在分析之后,以下多个母体因子与死产有着独立的相关性:非西语裔黑人人种/族裔、糖尿病、年龄40岁或以上、AB型血型、毒品使用及成瘾史、在妊娠前3个月期间的吸烟史、超重或肥胖、没有与一位伴侣生活。

有数个生殖史因素与死产有着强烈的相关性,其中包括先前有过死产,及有或没有先前不到20孕周时发生的自发性流产的未生产妇(即从来没有生过孩子的妇女)和此次怀孕的多产妇(多个胎儿,如双胞胎)。

文章的作者指出,总体而言,在妊娠伊始就已知的妊娠因素只占了很小的死产风险比例。他们写道,除了先前发生过死产或流产之外,其它风险因子的预测价值有限。(生物谷Bioon.com)

Association Between Stillbirth and Risk Factors Known at Pregnancy Confirmation

The Stillbirth Collaborative Research Network Writing Group

Context Stillbirths account for almost half of US deaths from 20 weeks' gestation to 1 year of life. Most large studies of risk factors for stillbirth use vital statistics with limited data.
Objective To determine the relation between stillbirths and risk factors that could be ascertained at the start of pregnancy, particularly the contribution of these factors to racial disparities.
Design, Setting, and Participants Multisite population-based case-control study conducted between March 2006 and September 2008. Fifty-nine US tertiary care and community hospitals, with access to at least 90% of deliveries within 5 catchment areas defined by state and county lines, enrolled residents with deliveries of 1 or more stillborn fetuses and a representative sample of deliveries of only live-born infants, oversampled for those at less than 32 weeks' gestation and those of African descent.
Main Outcome Measure Stillbirth.
Results Analysis included 614 case and 1816 control deliveries. In multivariate analyses, the following factors were independently associated with stillbirth: non-Hispanic black race/ethnicity (23.1% stillbirths, 11.2% live births) (vs non-Hispanic whites; adjusted odds ratio [AOR], 2.12 [95% CI, 1.41-3.20]); previous stillbirth (6.7% stillbirths, 1.4% live births); nulliparity with (10.5% stillbirths, 5.2% live births) and without (34.0% stillbirths, 29.7% live births) previous losses at fewer than 20 weeks' gestation (vs multiparity without stillbirth or previous losses; AOR, 5.91 [95% CI, 3.18-11.00]; AOR, 3.13 [95% CI, 2.06-4.75]; and AOR, 1.98 [95% CI, 1.51-2.60], respectively); diabetes (5.6% stillbirths, 1.6% live births) (vs no diabetes; AOR, 2.50 [95% CI, 1.39-4.48]); maternal age 40 years or older (4.5% stillbirths, 2.1% live births) (vs age 20-34 years; AOR, 2.41 [95% CI, 1.24-4.70]); maternal AB blood type (4.9% stillbirths, 3.0% live births) (vs type O; AOR, 1.96 [95% CI, 1.16-3.30]); history of drug addiction (4.5% stillbirths, 2.1% live births) (vs never use; AOR, 2.08 [95% CI, 1.12-3.88]); smoking during the 3 months prior to pregnancy (<10 cigarettes/d, 10.0% stillbirths, 6.5% live births) (vs none; AOR, 1.55 [95% CI, 1.02-2.35]); obesity/overweight (15.5% stillbirths, 12.4% live births) (vs normal weight; AOR, 1.72 [95% CI, 1.22-2.43]); not living with a partner (25.4% stillbirths, 15.3% live births) (vs married; AOR, 1.62 [95% CI, 1.15-2.27]); and plurality (6.4% stillbirths, 1.9% live births) (vs singleton; AOR, 4.59 [95% CI, 2.63-8.00]). The generalized R2 was 0.19, explaining little of the variance.
Conclusion Multiple risk factors that would have been known at the time of pregnancy confirmation were associated with stillbirth but accounted for only a small amount of the variance in this outcome.

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