title: Pregnancy disorders leading to very preterm birth influence neonatal outcomes: results of the population-based ACTION cohort study.
abstract: BACKGROUND
  We examined the relationships between -pregnancy disorders leading to very preterm birth -(spontaneous preterm labor, prelabor premature rupture of -membranes (PPROM), hypertension/preeclampsia, -intrauterine growth restriction (IUGR), antenatal hemorrhage, and maternal -infection), both in isolation and grouped together as -"disorders of placentation" (hypertensive disorders and IUGR) vs. -"presumed infection/inflammation" (all the others), and several unfavorable neonatal outcomes.
  
  
  METHODS
  We examined a population-based prospective cohort of 2,085 singleton infants of 23-31 wk gestational age (GA) born in six Italian regions (the Accesso alle Cure e Terapie Intensive Ostetriche e Neonatali (ACTION) study).
  
  
  RESULTS
  Neonates born following disorders of placentation had a higher GA and better overall outcomes than those born following infection/inflammation. After adjustment for GA, however, they showed higher risk of mortality (odds ratio, OR: 1.4; 95% confidence interval, CI: 1.0-2.0), bronchopulmonary dysplasia (BPD) (OR: 2.5; CI: 1.8-3.6), and retinopathy of prematurity (ROP) (OR: 2.0; CI: 1.1-3.5), especially in growth-restricted infants, and a lower risk of intraventricular hemorrhage (IVH) (OR: 0.5; CI: 0.3-0.8) and periventricular leukomalacia (PVL) (OR: 0.6; CI: 0.4-1.1) as compared with infants born following -infection/inflammation disorders.
  
  
  CONCLUSIONS
  Our data confirm the hypothesis that, in very preterm infants, adverse outcomes are both a function of immaturity (low GA) and of complications leading to preterm birth. The profile of risk is different in different pregnancy disorders.
authors.affiliation: Pediatrics and Neonatology Division, Woman and Child Health Department, Ospedale Versilia, Lido di Camaiore, Italy. l.gagliardi@neonatalnet.org
authors.forename: Luigi
authors.initials: L
authors.lastname: Gagliardi
authors.forename: Franca
authors.initials: F
authors.lastname: Rusconi
authors.forename: Monica
authors.initials: M
authors.lastname: Da Frè
authors.forename: Giorgio
authors.initials: G
authors.lastname: Mello
authors.forename: Virgilio
authors.initials: V
authors.lastname: Carnielli
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Lallo
authors.forename: Francesco
authors.initials: F
authors.lastname: Macagno
authors.forename: Silvana
authors.initials: S
authors.lastname: Miniaci
authors.forename: Carlo
authors.initials: C
authors.lastname: Corchia
authors.forename: Marina
authors.initials: M
authors.lastname: Cuttini
mesh_terms: D005260:Female; D005317:Fetal Growth Retardation; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011256:Pregnancy Outcome; D011446:Prospective Studies