Spinillo Arsenio, Bergante Carola, Gardella Barbara, Mainini Roberta, Montanari Laura
Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico S.Matteo, Piazzale Golgi 2, 27100 Pavia, Italy.
Acta Obstet Gynecol Scand. 2004 May;83(5):431-5. doi: 10.1111/j.0001-6349.2004.00295.x.
The role of antenatal risk factors associated with the occurrence of fetal growth restriction complicated by abnormal umbilical artery Doppler studies has not yet been studied extensively. We evaluated the role and the interactions of antenatal antecedents of fetal growth restriction complicated by abnormal umbilical artery end-diastolic velocities.
We compared antenatal variables in 183 pregnancies complicated by fetal growth retardation and abnormal umbilical artery Doppler studies and 549 appropriately grown fetuses with normal end-diastolic velocity waveform in the umbilical artery. Logistic regression was used to evaluate the association between antenatal variables and fetal growth retardation and to test for interaction.
In logistic models, increasing maternal age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.01-1.11], nulliparity (OR 2.2, 95% CI 1.37-3.5), smoking during pregnancy (OR 2.56, 95% CI 1.56-4.22), preeclampsia (OR 27.5, 95% CI 15.1-49.9), first-trimester hemorrhage (OR 2.25, 95% CI 1.32-3.82) and low (< 0.2 kg/week) weight gain in pregnancy (OR 3.48, 95% CI 1.71-3.05) were significantly associated with an increased risk of fetal growth restriction complicated by abnormal Doppler studies. These risk factors were also significantly correlated with the occurrence of absent/reversed end-diastolic blood flow in the umbilical artery. Maternal smoking during pregnancy interacted negatively with preeclampsia but positively with a low weight gain in pregnancy.
The results of this study have shown that antenatal risk factors for intrauterine growth retardation (IUGR) complicated by abnormal Doppler studies are similar to those associated with the birth of a small-for-gestational-age infant. Preeclampsia, maternal smoking and low weight gain in pregnancy play a significant causal role in the origin of fetal growth restriction associated with abnormal uteroplacental blood flow.
与胎儿生长受限合并脐动脉多普勒检查异常发生相关的产前危险因素尚未得到广泛研究。我们评估了胎儿生长受限合并脐动脉舒张末期血流速度异常的产前因素的作用及相互作用。
我们比较了183例合并胎儿生长迟缓及脐动脉多普勒检查异常的妊娠和549例脐动脉舒张末期速度波形正常、生长正常的胎儿的产前变量。采用逻辑回归评估产前变量与胎儿生长迟缓之间的关联并检验相互作用。
在逻辑模型中，母亲年龄增加[比值比（OR）1.06，95%置信区间（CI）1.01 - 1.11]、初产（OR 2.2，95% CI 1.37 - 3.5）、孕期吸烟（OR 2.56，95% CI 1.56 - 4.22）、子痫前期（OR 27.5，95% CI 15.1 - 49.9）、孕早期出血（OR 2.25，95% CI 1.32 - 3.82）以及孕期体重增加低（< 0.2 kg/周）（OR 3.48，95% CI 1.71 - 3.05）与合并多普勒检查异常的胎儿生长受限风险增加显著相关。这些危险因素也与脐动脉舒张末期血流缺失/反向的发生显著相关。孕期母亲吸烟与子痫前期呈负相互作用，但与孕期体重增加低呈正相互作用。
本研究结果表明，合并多普勒检查异常的宫内生长迟缓（IUGR）的产前危险因素与小于胎龄儿出生相关的危险因素相似。子痫前期、母亲吸烟和孕期体重增加低在与子宫胎盘血流异常相关的胎儿生长受限起源中起重要因果作用。
