背景:早产(PTB)是全球婴儿死亡率和发病率的主要原因。荷兰的PTB率正在下降,可能是由于预防策略的实施。在这项研究中,我们评估了近年来荷兰PTB发生率的总体趋势,并在特定的子组中更详细地调查在不久的将来需要审查的潜在组。
方法:基于国家围产期登记,我们纳入了荷兰2011年至2019年期间无严重先天性异常导致24~42周完成妊娠的所有孕妇.我们评估了两种不同临床亚型的PTB率(自发性与医源性)和五个胎龄亚组:24-27+6周(极端),28-31+6周(非常),32-33+6周(中度,34-36+6周[晚]和,总的来说,24-36+6周[总体PTB])。使用CochranArmitage检验进行趋势分析。我们还比较了前2年与后2年不同亚组的PTB发生率。分别分析单胎和多胎妊娠。
结果:我们在研究中纳入了1447689例单胎妊娠和23250例多胎妊娠。在单身人士中,我们观察到PTB从5.5%显著下降到5.0%(p<0.0001),主要是由于医源性PTB的减少。当关注不同胎龄亚组时,所有医源性PTB和中度至晚期自发性PTB均下降.然而,在自发性极端和非常PTB中,有显著增加。在评估不同亚组的总体PTB风险时,下降仅在年龄≥25岁的女性中可见,未产和初产妇女,具有中等或高社会经济地位的妇女和高血压妇女。在倍数中,PTB的比率保持相当稳定,从2011年的52.3%增加到2019年的54.1%(p=0.57)。
结论:在荷兰,2011年至2019年,PTB下降,主要是由于晚期PTB的减少,医源性高于自发性PTB。在不久的将来,重点应该放在看不到下降的特定子群体上,例如社会经济地位较低或年龄较小的女性。
BACKGROUND: Preterm birth (PTB) is the leading cause of infant mortality and morbidity worldwide. Rates of PTB in the Netherlands are declining, possibly due to the implementation of preventive strategies. In this
study we assessed the overall trend in PTB rates in the Netherlands in recent years, and in more detail in specific subgroups to investigate potential groups that require scrutiny in the near future.
METHODS: Based on the national perinatal registry, we included all pregnancies without severe congenital abnormalities resulting in a birth from 24 to 42 completed weeks of gestation between 2011 and 2019 in the Netherlands. We assessed PTB rates in two different clinical subtypes (spontaneous vs.
iatrogenic) and in five gestational age subgroups: 24-27+6 weeks (extreme), 28-31+6 weeks (very), 32-33+6 weeks (moderate, 34-36+6 weeks [late] and, in general, 24-36+6 weeks [overall PTB]). Trend analysis was performed using the Cochran Armitage test. We also compared PTB rates in different subgroups in the first 2 years compared to the last 2 years. Singleton and multiple gestations were analyzed separately.
RESULTS: We included 1 447 689 singleton and 23 250 multiple pregnancies in our
study. In singletons, we observed a significant decline in PTB from 5.5% to 5.0% (p < 0.0001), mainly due to a decrease in
iatrogenic PTBs. When focusing on different gestational age subgroups, there was a decrease in all
iatrogenic PTB and in moderate to late spontaneous PTB. However, in spontaneous extreme and very PTB there was an significant increase. When assessing overall PTB risk in different subgroups, the decline was only visible in women with age ≥25 years, nulliparous and primiparous women, women with a medium or high socioeconomic status and hypertensive women. In multiples, the rate of PTB remained fairly stable, from 52.3% in 2011 to 54.1% in 2019 (p = 0.57).
CONCLUSIONS: In the Netherlands, between 2011 and 2019, PTB decreased, mainly due to a reduction in late PTB, and more in iatrogenic than in spontaneous PTB. Focus for the near future should be on specific subgroups in which the decline was not visible, such as women with a low socioeconomic status or a young age.