CDC Grand Rounds：早産防止の公衆衛生戦略

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ホーム IMICライブラリ MMWR抄訳 2016年（Vol.65)CDC Grand Rounds：早産防止の公衆衛･･･

MMWR抄訳

2016/08/19Vol. 65 / No. 32

MMWR65(32):826－830
CDC Grand Rounds: Public Health Strategies to Prevent Preterm Birth

2013年、アメリカでは400万人近い生産児のうち約11.4％が早産(妊娠37週0/7日未満での出産)であり、新生児死亡(8,470例)の36％を占める。とくに妊娠32週0/7日未満での出産は死亡率、疾病率がもっとも高く、早産に関連する疾病として呼吸窮迫症候群、壊死性腸炎、脳室内出血、長期的には発達遅延、学業低下などが挙げられる。アメリカでの早産率は1990年：10.6%から2006年：12.8％と21％増加し、その後2007年は10.4％、2014年には9.6％に低下している。2014年の人種/民族別早産率は非ヒスパニック系黒人(13.2％)がもっとも高く、アメリカインディアン/アラスカ原住民(AI/AN)：10.2％、ヒスパニック系：9.4％、非ヒスパニック系白人：8.9％、アジア/太平洋諸島系(API)：8.5％の順であった。新生児の死亡率(生産児1,000人あたりの生後12カ月以内死亡数)は、1980年：12.6から2013年：5.96と大きく低下(53％)、人種/民族別の死亡率は非ヒスパニック系黒人(11.2)にて非ヒスパニック系白人(5.1)の約2.2倍高値であった。また、早産による乳児死亡率は黒人女性にて4.9、AI/AN:2.0、ヒスパニック系：1.8、白人：1.6、API：1.5であった。早産とその合併症を予防するためには、1)妊娠可能年齢女性は妊娠前ケアサービスを受ける、2)早産リスクにある女性は早産の対する有効な治療を受ける、3)妊娠39週0/7日以前の医学的な適応のない帝王切開を避ける、4)非意図的な妊娠を阻止し、適切な出産間隔を空ける、5)早産リスクの高い多胎妊娠を避けるなどが有効であり、CDC’s Maternal and Child Health Epidemiology programなどの介入が行われている。さらにAmerican College of Obstetricians and Gynecologists (ACOG)、American Academy of Pediatrics、March of Dimes’(MOD)、Collaboration on Innovation and Improvement Network、Association of State and Territorial Health Officials’ Healthy Babies Initiativeおよび州ベースのPerinatal Quality Collaboratives (PQCs)などと共同して早産率の低下を目的とした戦略が展開されている。

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