Early term deliveries and long-term endocrine and metabolic morbidity of the offspring

Dorit Paz-Levy, Eyal Sheiner, Tamar Wainstock, Daniella Landau, Asnat Walfisch

פרסום מחקרי: פרסום בכתב עתתקציר הצגה בכנס

תקציר

Objective
Prematurity is known to be associated with high rates of endocrine complications. We aimed to determine whether early term delivery (37-38+6 weeks’ gestation) impacts on long term pediatric endocrine and metabolic morbidity.

Study Design
A population-based prospective cohort analysis was performed including all term singleton deliveries occurring between 1991-2013 at a single tertiary medical center. Fetuses with congenital malformations and multiple pregnancies were excluded. Gestational age upon delivery was sub-divided into: early, full (39 - 40+6 weeks’ gestation), late (41 - 41+6 weeks’ gestation) and post term (≥42 weeks). Morbidity up to the age of 18 years involving the endocrine system was evaluated. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence. A Cox hazards regression model was used to control for confounders.

Results
During the study period 225,260 term deliveries met the inclusion criteria. Of them, 24% (n=54,073) occurred at early term. Hospitalizations up to the age of 18 years, involving endocrine-metabolic morbidities were significantly more common in the early term group as compared with full and late term delivery groups (Table). Specifically, diabetes mellitus and over-weight were significantly more common among the early term group (p<0.05). The survival curve demonstrated significantly higher cumulative incidence of endocrine morbidity in the early term group (Figure, log rank p<0.001). In the Cox regression model, while controlling for multiple confounders such as maternal diabetes, hypertension, labor induction, and Apgar score, early term delivery exhibited an independent association with long-term childhood endocrine or metabolic morbidity (adjusted HR = 1.3, CI 1.1-1.5, p=0.02) and more so beyond the age of 5 years (adjusted HR =1.4, CI 1.2-1.7, p<0.001).

Conclusion
Deliveries occurring at early term are associated with higher rates of long term pediatric endocrine and metabolic morbidities compared with full and late term deliveries.
שפה מקוריתאנגלית
עמודים (מ-עד)S352-S352
כתב עתAmerican Journal of Obstetrics and Gynecology
כרך216
מספר גיליון1
מזהי עצם דיגיטלי (DOIs)
סטטוס פרסוםפורסם - ינו׳ 2017

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