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Am J Obstet Gynecol. 2017 May;216(5):518.e1-518.e12. doi: 10.1016/j.ajog.2017.01.002. Epub 2017 Jan 16.

Leading causes of preterm delivery as risk factors for intraventricular hemorrhage in very preterm infants: results of the EPIPAGE 2 cohort study.

Author information

1
Grenoble Alps University, Centre national de la recherche scientifique, TIMC-IMAG, Unite mixte de recherche 5525 ThEMAS, and Neonatal Intensive Care Unit, Grenoble University Hospital, Grenoble, France. Electronic address: MChevallier3@chu-grenoble.fr.
2
Grenoble Alps University, Centre national de la recherche scientifique, TIMC-IMAG, Unite mixte de recherche 5525 ThEMAS, and Neonatal Intensive Care Unit, Grenoble University Hospital, Grenoble, France.
3
Institut national de la sante de de la recherche médicale, U1153, Epidemiology and Statistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Maternité Port-Royal, Paris, France; Neonatal Intensive Care Unit, Jeanne de Flandre Hospital, Lille, France.
4
Institut national de la sante de de la recherche médicale, U1153, Epidemiology and Statistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Maternité Port-Royal, Paris, France.
5
Institut national de la sante de de la recherche médicale, U1153, Epidemiology and Statistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Maternité Port-Royal, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Assistance publique des hôpitaux de Paris, Paris, France; Pierre et Marie Curie University, Paris, France.
6
Institut national de la sante de de la recherche médicale, U1153, Epidemiology and Statistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Maternité Port-Royal, Paris, France; Department of Obstetrics and Gynecology, DHU Risks and Pregnancy, Maternity Port-Royal Hospital, Cochin Assistance publique des hôpitaux de Paris, Paris, France; Paris Descartes University France, Paris, France.
7
Region Inserm Team ERI 28, Neovasc, Normandie University, Rouen, France; Neonatal Intensive Care Unit, Rouen University Hospital, Rouen, France.
8
Institut national de la sante de de la recherche médicale, U1153, Epidemiology and Statistics Sorbonne Paris Cité Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Maternité Port-Royal, Paris, France; Paris Descartes University France, Paris, France; Unite de recherche clinique-Centre d'investigation clinique P1419, Département hospitalo-universitaire Risk in Pregnancy, Cochin Hotel-Dieu Hospital, Assistance publique des hôpitaux de Paris, Paris, France.

Abstract

BACKGROUND:

Intraventricular hemorrhage is a major risk factor for neurodevelopmental disabilities in preterm infants. However, few studies have investigated how pregnancy complications responsible for preterm delivery are related to intraventricular hemorrhage.

OBJECTIVE:

We sought to investigate the association between the main causes of preterm delivery and intraventricular hemorrhage in very preterm infants born in France during 2011 between 22-31 weeks of gestation.

STUDY DESIGN:

The study included 3495 preterm infants from the national EPIPAGE 2 cohort study who were admitted to neonatal intensive care units and had at least 1 cranial ultrasound assessment. The primary outcome was grade I-IV intraventricular hemorrhage according to the Papile classification. Multinomial logistic regression models were used to study the relationship between risk of intraventricular hemorrhage and the leading causes of preterm delivery: vascular placental diseases, isolated intrauterine growth retardation, placental abruption, preterm labor, and premature rupture of membranes, with or without associated maternal inflammatory syndrome.

RESULTS:

The overall frequency of grade IV, III, II, and I intraventricular hemorrhage was 3.8% (95% confidence interval, 3.2-4.5), 3.3% (95% confidence interval, 2.7-3.9), 12.1% (95% confidence interval, 11.0-13.3), and 17.0% (95% confidence interval, 15.7-18.4), respectively. After adjustment for gestational age, antenatal magnesium sulfate therapy, level of care in the maternity unit, antenatal corticosteroids, and chest compressions, infants born after placental abruption had a higher risk of grade IV and III intraventricular hemorrhage compared to those born under placental vascular disease conditions, with adjusted odds ratios of 4.3 (95% confidence interval, 1.1-17.0) and 4.4 (95% confidence interval, 1.1-17.6), respectively. Similarly, preterm labor with concurrent inflammatory syndrome was associated with an increased risk of grade IV intraventricular hemorrhage (adjusted odds ratio, 3.4; 95% confidence interval, 1.1-10.2]). Premature rupture of membranes did not significantly increase the risk.

CONCLUSION:

Relationships between the causes of preterm birth and intraventricular hemorrhage were limited to specific and rare cases involving acute hypoxia-ischemia and/or inflammation. While the emergent nature of placental abruption would challenge any attempts to optimize management, the prenatal care offered during preterm labor could be improved.

KEYWORDS:

cohort study; intraventricular hemorrhage; maternal event; risk factor; very preterm infant

PMID:
28104401
DOI:
10.1016/j.ajog.2017.01.002
[Indexed for MEDLINE]

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