BACKGROUND:Unexplained stillbirth and the sudden infant death syndrome (SIDS)share some features.A raised maternal serum level of alpha-fetoprotein during the second trimester of pregnancy is a marker of placental dys...BACKGROUND:Unexplained stillbirth and the sudden infant death syndrome (SIDS)share some features.A raised maternal serum level of alpha-fetoprotein during the second trimester of pregnancy is a marker of placental dysfunction and a strong predictor o f the risk of unexplained stillbirth.It is unknown whether alpha -fetoprotein levels also predict the risk of SIDS.METHODS:We linked a prenatal -screening database for wo men in western Scot-land with databases of maternity,perinatal death,and birth and death certifications to assess t he association between second -trimester levels of maternal serum alpha -feto-protein and the subsequent risk of SI DS.RESULTS:A-mong 214,532women with singleton bi rths,there were114cases of SIDS(incidence,2.7per 10,000births a-mong women with alpha -fetoprotein l evels in the lowest quintile and 7.5per 10,000births am ong those with levels in the highest quintile).When the lowest quintile was used as a referent,the unadjusted odds ra tios for SIDS for the second through fifth quintiles were1.7(95percent confi-dence interval,0.8to 3.5),1.8(95percent confidence interval,0.9to 3.7),2.5(95percent confidence inter-val,1.3to 4.8),and 2.8(95percent confidence inter-val,1.4to 5.4),respectively(P for trend =0.001).The risk of SIDS varied inversely with th e birth -weight per-centile and the gestational age at delivery;after adjustment for these factors,the odds ratios fo r SIDS were 1.7(95percent confidence interval,0.8to3.5),1.7(95percent confidence interval,0.8to 3.5),2.2(95percent confi-dence interval,1.1to 4.4),and 2.2(95percent confi-dence interval,1.1to 4.3),respectively(P for trend =0.01).CONCLUSIONS:There is a direct asso ciation be-tween second -trimester maternal se rumalpha -fetoprotein levels and the risk of SIDS,which may be mediated in part through impaired fetal growth and pr eterm birth.展开更多
文摘BACKGROUND:Unexplained stillbirth and the sudden infant death syndrome (SIDS)share some features.A raised maternal serum level of alpha-fetoprotein during the second trimester of pregnancy is a marker of placental dysfunction and a strong predictor o f the risk of unexplained stillbirth.It is unknown whether alpha -fetoprotein levels also predict the risk of SIDS.METHODS:We linked a prenatal -screening database for wo men in western Scot-land with databases of maternity,perinatal death,and birth and death certifications to assess t he association between second -trimester levels of maternal serum alpha -feto-protein and the subsequent risk of SI DS.RESULTS:A-mong 214,532women with singleton bi rths,there were114cases of SIDS(incidence,2.7per 10,000births a-mong women with alpha -fetoprotein l evels in the lowest quintile and 7.5per 10,000births am ong those with levels in the highest quintile).When the lowest quintile was used as a referent,the unadjusted odds ra tios for SIDS for the second through fifth quintiles were1.7(95percent confi-dence interval,0.8to 3.5),1.8(95percent confidence interval,0.9to 3.7),2.5(95percent confidence inter-val,1.3to 4.8),and 2.8(95percent confidence inter-val,1.4to 5.4),respectively(P for trend =0.001).The risk of SIDS varied inversely with th e birth -weight per-centile and the gestational age at delivery;after adjustment for these factors,the odds ratios fo r SIDS were 1.7(95percent confidence interval,0.8to3.5),1.7(95percent confidence interval,0.8to 3.5),2.2(95percent confi-dence interval,1.1to 4.4),and 2.2(95percent confi-dence interval,1.1to 4.3),respectively(P for trend =0.01).CONCLUSIONS:There is a direct asso ciation be-tween second -trimester maternal se rumalpha -fetoprotein levels and the risk of SIDS,which may be mediated in part through impaired fetal growth and pr eterm birth.
