Abstract
Background:
We examined the relationships between pregnancy disorders leading to very preterm birth (spontaneous preterm labor, prelabor premature rupture of membranes (PPROM), hypertension/preeclampsia, intrauterine growth restriction (IUGR), antenatal hemorrhage, and maternal infection), both in isolation and grouped together as “disorders of placentation” (hypertensive disorders and IUGR) vs. “presumed infection/inflammation” (all the others), and several unfavorable neonatal outcomes.
Methods:
We examined a population-based prospective cohort of 2,085 singleton infants of 23–31 wk gestational age (GA) born in six Italian regions (the Accesso alle Cure e Terapie Intensive Ostetriche e Neonatali (ACTION) study).
Results:
Neonates born following disorders of placentation had a higher GA and better overall outcomes than those born following infection/inflammation. After adjustment for GA, however, they showed higher risk of mortality (odds ratio, OR: 1.4; 95% confidence interval, CI: 1.0–2.0), bronchopulmonary dysplasia (BPD) (OR: 2.5; CI: 1.8–3.6), and retinopathy of prematurity (ROP) (OR: 2.0; CI: 1.1–3.5), especially in growth-restricted infants, and a lower risk of intraventricular hemorrhage (IVH) (OR: 0.5; CI: 0.3–0.8) and periventricular leukomalacia (PVL) (OR: 0.6; CI: 0.4–1.1) as compared with infants born following infection/inflammation disorders.
Conclusion:
Our data confirm the hypothesis that, in very preterm infants, adverse outcomes are both a function of immaturity (low GA) and of complications leading to preterm birth. The profile of risk is different in different pregnancy disorders.
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Acknowledgements
Hospitals and participants in the ACTION project have been listed in the Appendix. This article is affectionately dedicated to Eva Buiatti. As chief of the Epidemiological Section of the Regional Health Agency of Tuscany, she was, until her untimely death, a continuing source of inspiration and of generous support to this project.
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Gagliardi, L., Rusconi, F., Da Frè, M. et al. Pregnancy disorders leading to very preterm birth influence neonatal outcomes: results of the population-based ACTION cohort study. Pediatr Res 73, 794–801 (2013). https://doi.org/10.1038/pr.2013.52
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DOI: https://doi.org/10.1038/pr.2013.52
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