Does infant birthweight percentile identify mothers at risk of severe morbidity? A Canadian population-based cohort study.

Joel G Ray, Howard Berger, Kazuyoshi Aoyama, Jocelynn L Cook, Kayvan Aflaki, Alison L Park
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Abstract

Background: There is a reverse J-shaped relation between newborn weight percentile and risk of perinatal mortality. Perinatal mortality itself is associated with severe maternal morbidity and mortality (SMM-M) around the index pregnancy, likely because the two share common etiologies, including placental dysfunction. We evaluated an infant's birthweight percentile and risk of its mother experiencing SMM-M.

Methods: This population-based cohort study was completed within a universal healthcare system in Ontario, Canada. Included were 2,203,490 singleton livebirths between 2002 and 2020. The study exposure was infant birthweight percentile for gestational age and sex. The 25th to 75th percentile served as the referent. The main outcome was SMM-M arising from 23 week's gestation up to 42 days postpartum. Multivariable modified Poisson regression generated relative risks (aRRs) and 95% confidence intervals (CI), adjusted for maternal age, income, rurality, pre-existing diabetes and hypertension.

Results: A J-shaped relation was seen between birthweight and risk of SMM-M. Relative to the 25th to 75th (15.0 per 1000 livebirths), the aRR of SMM-M was 1.27 (95% CI 1.21, 1.32) at 5th to < 10th, 1.40 (95% CI 1.28, 1.53) at 2nd to < 3rd, and 1.48 (95% CI 1.36, 1.62) at < 1st birthweight percentile. At higher birthweights, the aRR was 1.16 (95% CI 1.11, 1.21) at 90th to < 95th, 1.24 (95% CI 1.13, 1.36) at 95th to < 96th, and 1.73 (95% CI 1.60, 1.87) at > 99th percentile.

Conclusion: There is a J-shaped relation between infant birthweight and risk of its mother experiencing SMM-M, likely due to shared risk factors and a common pathogenesis.

婴儿出生体重百分位数是否能确定母亲有严重发病率的风险?一项加拿大人群队列研究。
背景:新生儿体重百分位数与围产期死亡风险呈反j型关系。围产期死亡率本身与严重的孕产妇发病率和死亡率(SMM-M)有关,可能是因为两者具有共同的病因,包括胎盘功能障碍。我们评估了婴儿的出生体重百分位数及其母亲经历SMM-M的风险。方法:这项基于人群的队列研究是在加拿大安大略省的全民医疗保健系统中完成的。其中包括2002年至2020年间的2203490例单胎活产。研究暴露是婴儿出生体重百分位数的胎龄和性别。以第25 ~ 75百分位为参照。主要指标为妊娠23周至产后42天出现的SMM-M。多变量修正泊松回归生成相对危险度(aRRs)和95%置信区间(CI),校正了产妇年龄、收入、农村状况、既往糖尿病和高血压。结果:出生体重与SMM-M发病呈“j”型关系。相对于第25至75名(15.0 / 1000活产),SMM-M在第5至99个百分位数的aRR为1.27 (95% CI 1.21, 1.32)。结论:婴儿出生体重与其母亲患SMM-M的风险呈j型关系,可能存在共同的危险因素和共同的发病机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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