Back to Search
Start Over
Phenotypic Classification of Preterm Birth Among Nulliparous Women: A Population-Based Cohort Study.
- Source :
-
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC [J Obstet Gynaecol Can] 2019 Oct; Vol. 41 (10), pp. 1423-1432.e9. Date of Electronic Publication: 2019 Apr 30. - Publication Year :
- 2019
-
Abstract
- Objective: A classification model based on preterm birth clinical presentations (phenotypes) was proposed at the International Conference on Prematurity and Stillbirth, with calls for validation. This study sought to determine the distribution of clinical phenotypes of preterm birth among nulliparous women, their corresponding associations with maternal characteristics, and the odds ratios (ORs) of preterm Caesarean section and other adverse outcomes.<br />Methods: A population-based cohort study was performed of all nulliparous women with singleton pregnancies (>20 weeks) who gave birth in a hospital in Ontario between 2012 and 2014. Logistic regression models were used to estimate adjusted ORs (Canadian Task Force Classification II-2).<br />Results: Among 113 942 nulliparous women, 6.1% delivered at <37 weeks, at a mean gestational age of 33.9 weeks. Of those women, 34.1% did not meet the criteria for the presence of any clinical phenotype; 42.3% had one maternal, fetal, or placental condition; 22.3% had two clinical conditions; and 1.3% had three clinical conditions. The most common preterm birth phenotypes were worsening of maternal diseases (24.0%), intrauterine growth restriction (23.5%), and fetal distress (23.0%). Compared with preterm births without any significant clinical phenotype, those with maternal, fetal, or placental phenotypes were associated with increased odds of Caesarean section (adjusted ORs 2.70 [95% confidence interval [CI] 2.30-3.17], 1.66 [95% CI 1.36-2.03], and 6.49 [95% CI 4.29-9.80], respectively).<br />Conclusion: Approximately two thirds of nulliparous preterm births were grouped into distinct clinical phenotypes. This study demonstrated that outcomes varied across phenotypes, thus providing evidence of benefit for the phenotypic classification model.<br /> (Copyright © 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Abruptio Placentae epidemiology
Adolescent
Adult
Anemia epidemiology
Chorioamnionitis epidemiology
Cohort Studies
Congenital Abnormalities epidemiology
Eclampsia epidemiology
Female
Fetal Death
Fetal Distress epidemiology
Fetal Growth Retardation epidemiology
Humans
Logistic Models
Odds Ratio
Oligohydramnios epidemiology
Ontario epidemiology
Perinatal Death
Phenotype
Placenta Previa epidemiology
Polyhydramnios epidemiology
Pre-Eclampsia epidemiology
Pregnancy
Pregnancy Complications, Infectious epidemiology
Premature Birth epidemiology
Rh Isoimmunization epidemiology
Uterine Rupture epidemiology
Young Adult
Cesarean Section statistics & numerical data
Fetal Diseases epidemiology
Parity
Placenta Diseases epidemiology
Pregnancy Complications epidemiology
Premature Birth classification
Subjects
Details
- Language :
- English
- ISSN :
- 1701-2163
- Volume :
- 41
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC
- Publication Type :
- Academic Journal
- Accession number :
- 31053564
- Full Text :
- https://doi.org/10.1016/j.jogc.2019.02.005