Cesarean delivery is not associated with decreased at-birth fracture rates in osteogenesis imperfecta

被引：35

作者：

Bellur, S. ^{[1
]}

Jain, M. ^{[1
]}

Cuthbertson, D. ^{[2
]}

Krakow, D. ^{[3
,4
,5
]}

Shapiro, J. R. ^{[6
]}

Steiner, R. D. ^{[7
,8
,9
,10
,11
,12
]}

Smith, P. A. ^{[13
]}

Bober, M. B. ^{[14
]}

Hart, T. ^{[15
]}

Krischer, J. ^{[2
]}

Mullins, M. ^{[1
]}

Byers, P. H. ^{[16
,17
]}

Pepin, M. ^{[16
,17
]}

Durigova, M. ^{[18
,19
]}

Glorieux, F. H. ^{[18
,19
]}

Rauch, F. ^{[18
,19
]}

Sutton, V. R. ^{[1
,20
]}

Lee, B. ^{[1
,20
]}

Nagamani, S. C. ^{[1
,20
]}

机构：

[1] Baylor Coll Med, Dept Mol & Human Genet, Houston, TX 77030 USA

[2] Univ S Florida, Coll Med, Tampa, FL USA

[3] Univ Calif Los Angeles, Dept Orthoped Surg, Los Angeles, CA USA

[4] Univ Calif Los Angeles, Dept Human Genet, Los Angeles, CA USA

[5] Univ Calif Los Angeles, Dept Obstet & Gynecol, Los Angeles, CA 90024 USA

[6] Kennedy Krieger Inst, Dept Bone & Osteogenesis Imperfecta, Baltimore, MD USA

[7] Oregon Hlth & Sci Univ, Dept Pediat, 3181 Sw Sam Jackson Pk Rd, Portland, OR 97201 USA

[8] Oregon Hlth & Sci Univ, Dept Mol & Med Genet, Portland, OR 97201 USA

[9] Marshfield Clin Res Fdn, Marshfield, WI USA

[10] Univ Wisconsin, Marshfield, WI USA

[11] Marshfield Clin Res Fdn, Madison, WI USA

[12] Univ Wisconsin, Madison, WI USA

[13] Shriners Hosp Children, Chicago, IL USA

[14] Alfred I DuPont Hosp Children, Div Med Genet, Wilmington, DE USA

[15] Osteogenesis Imperfecta Fdn, Gaithersburg, MD USA

[16] Univ Washington, Dept Med, Div Med Genet, Seattle, WA 98195 USA

[17] Univ Washington, Dept Pathol, Div Med Genet, Seattle, WA 98195 USA

[18] Shriners Hosp Children, Dept Orthoped Surg, Montreal, PQ, Canada

[19] McGill Univ, Montreal, PQ, Canada

[20] Texas Childrens Hosp, Houston, TX 77030 USA

来源：

GENETICS IN MEDICINE | 2016年 / 18卷 / 06期

关键词：

at-birth fracture; cesarean delivery; in utero fracture; natural history study; osteogenesis imperfecta; FETAL SKELETAL DYSPLASIAS; PRENATAL-DIAGNOSIS; PREGNANCY; MACROSOMIA; MANAGEMENT; MORBIDITY;

D O I：

10.1038/gim.2015.131

中图分类号：

Q3 [遗传学];

学科分类号：

071007 ; 090102 ;

摘要：

Purpose: Osteogenesis imperfecta (OI) predisposes to recurrent fractures. Patients with the moderate to severe forms of OI present with antenatal fractures, and the mode of delivery that would be safest for the fetus is not known. Methods: We conducted systematic analyses of the largest cohort of individuals with OI (n = 540) enrolled to date in the CM Linked Clinical Research Centers. Self-reported at-birth fracture rates were compared among individuals with OI types I, III, and IV. Multivariate analyses utilizing backward-elimination logistic regression model building were performed to assess the effect of multiple covariates, including method of delivery, on fracture-related Outcomes. Results: When accounting for other covariates, at-birth fracture rates did not differ based on whether delivery was by vaginal route or by cesarean delivery (CD). Increased birth weight conferred higher risk for fractures irrespective of the delivery method. In utero fracture, maternal history of OI, and breech presentation were strong predictors for choosing CD. Conclusion: Our study, the largest to analyze the effect of various factors on at-birth fracture rates in OI, shows that CD is not associated with decreased fracture rate. With the limitation that the fracture data were self-reported in this cohort, these results suggest that CD should be performed only for other maternal or fetal indications, not for the sole purpose of fracture prevention in OI.

引用

页码：570 / 576

页数：7

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