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Preterm birth in pregnancies complicated by major congenital malformations: a population-based study.

AbstractOBJECTIVE:
The objective of the study was to estimate and compare the relative risk of preterm birth (PTB) in pregnancies complicated by 1 or more of 8 major congenital malformations (MCMs).
STUDY DESIGN:
This was a population-based cohort study of the birth database of the Missouri Department of Health (1989-1997) including 678,693 singleton live births. Outcomes included a binary composite variable of any MCM and the following 8 individual malformations: spina bifida, diaphragmatic hernia, renal agenesis, other urogenital anomaly, tracheoesophageal fistula/esophageal atresia, omphalocele/gastroschisis, cardiac defect, and cleft lip/palate. Chromosomal anomalies were excluded. Logistic regression analyses assessed the association between malformations and PTB.
RESULTS:
The risk of PTB increased significantly and to varying degrees for each malformation. In pregnancies with any MCM, there was an increased prevalence (11.5%) and relative risk (adjusted odds ratio [(adj)OR] 3.2 [95% confidence interval (CI) 2.9 to 3.6]) of PTB at less than 35 weeks' gestation. The magnitude of risk increase was greatest at the earliest gestational ages: (adj)OR 4.8 (95% CI, 4.0 to 5.7) at less than 28 weeks. Pregnancies with multiple malformations were at highest risk for PTB: (adj)OR 8.0 [95% CI, 4.6 to 14.1].
CONCLUSION:
MCMs significantly increase PTB risk. The risk varies by malformation type and is higher with multiple malformations.
AuthorsStephanie E Purisch, Emily A DeFranco, Louis J Muglia, Anthony O Odibo, David M Stamilio
JournalAmerican journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 199 Issue 3 Pg. 287.e1-8 (Sep 2008) ISSN: 1097-6868 [Electronic] United States
PMID18771986 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
Topics
  • Abnormalities, Multiple (epidemiology)
  • Adult
  • Cleft Lip (epidemiology)
  • Cleft Palate (epidemiology)
  • Female
  • Gastroschisis (epidemiology)
  • Heart Defects, Congenital (epidemiology)
  • Hernia, Diaphragmatic (epidemiology)
  • Hernia, Umbilical (epidemiology)
  • Humans
  • Logistic Models
  • Pregnancy
  • Premature Birth (epidemiology)
  • Risk Factors
  • Spinal Dysraphism (epidemiology)
  • Tracheoesophageal Fistula (epidemiology)

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