摘要
目的调查本院有晚期早产风险的孕妇产前糖皮质激素的使用模式,评估最佳给药时机(距第1剂地塞米松给药后2~7 d分娩)的可能性及影响因素。方法回顾性研究155名2016年1月至2022年12月本院分娩的在妊娠34~36周使用产前糖皮质激素的孕妇,年龄23~54岁,其中119名孕妇在34~36周接受了产前糖皮质激素治疗,在37周前分娩;另有36名孕妇在妊娠34~36周接受了产前糖皮质激素治疗,但在足月分娩。根据产前糖皮质激素给药指征分为自发性早产风险组(98名)和医源性早产风险组(57名),自发性早产风险组孕妇年龄(31.8±4.3)岁,医源性早产风险组年龄(32.2±3.9)岁。比较两组产前糖皮质激素给药时机及孕妇特征的差异。进行多变量Logistic回归分析调整混杂因素,评估与最佳给药时机相关的影响因素。结果155名有早产风险的孕妇在34~36周期间接受了产前糖皮质激素治疗,产前糖皮质激素最优给药时机的发生率为29.7%。其中医源性早产风险组孕妇在最优给药时机接受产前糖皮质激素治疗的比例显著高于自发性早产风险组(P<0.05)。与医源性早产风险组相比,自发性早产风险组的孕妇在接受产前糖皮质激素给药后间隔>7 d分娩更常见(P<0.05),发生足月分娩的机率更高(P<0.05)。Logistic回归分析显示,医源性早产风险的孕妇在最优给药时机接受产前糖皮质激素治疗的机会是自发性早产风险孕妇的8.68倍(95%CI:2.69~28.02),胎膜早破的孕妇接受产前糖皮质激素最优给药时机的机会是无胎膜早破孕妇的4.09倍(95%CI:1.24~13.45)。结论不论给药指征如何,有晚期早产风险的孕妇在最佳给药时机接受产前糖皮质激素的可能性均很低。但产前糖皮质激素给药指征为医源性早产的孕妇更有可能在最佳给药时机接受产前糖皮质激素治疗。除此以外,胎膜早破也是产前糖皮质激素最优给药时机的影响因素。
Objective To investigate the use patterns of antenatal corticosteroids among pregnant women at risk of late preterm birth,and to evaluate the likelihood and influencing factors of administering the treatment at the optimal time(delivery within 2-7 days after the first dose of dexamethasone).Methods A retrospective study was conducted among 155 pregnant women(aged 23-54 years)who gave birth at our hospital between January 2017 and December 2022,who received antenatal corticosteroids during gestational weeks 34-36.119 pregnant women received antenatal corticosteroids therapy during weeks 34-36 and delivered before 37 weeks,while another 36 pregnant women received antenatal corticosteroids during weeks 34-36 but delivered at term.Based on the indications for antenatal corticosteroid administration,the participants were divided into spontaneous preterm birth risk group(98 pregnant women)and iatrogenic preterm birth risk group(57 pregnant women).The average age of pregnant women in the spontaneous preterm birth risk group were(31.8±4.3)years,and that of the iatrogenic preterm birth risk group was(32.2±3.9)years.The timing of antenatal corticosteroid administration and maternal characteristics were compared between the two groups.Multivariable logistic regression was conducted to adjust for confounding factors and assess the factors associated with optimal timing of antenatal corticosteroid administration.Results The prevalence of optimal timing of antenatal corticosteroid administration was 29.7%.The proportion of women receiving corticosteroids at the optimal time in the iatrogenic preterm birth group was significantly higher than in the spontaneous preterm birth(P<0.05).Compared to the iatrogenic preterm birth,women in the spontaneous preterm birth were more likely to have a delivery interval>7 days after the administration of antenatal corticosteroids(P<0.05)and had a higher probability of delivering at full term(P<0.05).Logistic regression analysis revealed that women in the iatrogenic preterm birth group were 8.68 times more likely to receive antenatal corticosteroids at the optimal time than those in spontaneous preterm birth(95%CI:2.69-28.02).Additionally,women with premature rupture of membranes were 4.09 times more likely to receive antenatal corticosteroids at the optimal time than those without premature rupture of membranes(95%CI:1.24-13.45).Conclusion Regardless of the indication for late preterm antenatal corticosteroid administration,the likelihood of pregnant women at risk of late preterm birth receiving optimal timing of antenatal corticosteroid administration was low.However,women with risk of iatrogenic preterm birth were more likely to receive antenatal corticosteroid at the optimal time of administration.In addition,premature rupture of membranes is also a factor influencing the timing of optimal antenatal corticosteroid administration.
作者
王慧
刘晨
曹丽芳
张雪峰
WANG Hui;LIU Chen;CAO Lifang;ZHANG Xuefeng(Department of Neonatology,Peking University International Hospital,Beijing 102206,China;不详)
出处
《中国生育健康杂志》
2024年第6期536-541,共6页
Chinese Journal of Reproductive Health
基金
北京大学国际医院院内科研基金(YN2021QN07)。
关键词
晚期早产
产前糖皮质激素
最佳给药时机
自发性早产
医源性早产
late preterm birth
antenatal corticosteroid
the timing of optimal administration
spontaneous preterm birth
iatrogenic preterm birth
