Hemachandra Anusha H, Klebanoff Mark A
Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA.
Am J Hum Biol. 2006 Nov-Dec;18(6):791-7. doi: 10.1002/ajhb.20552.
The developmental origins of the health and disease hypothesis suggests that fetal growth restriction (FGR) is a risk factor for several chronic diseases of adulthood. However, most supporting studies use birth weight as a proxy measure of FGR. To examine the relationship between birth weight and FGR, the present study used serial prenatal ultrasound to identify periods of FGR during gestation, and related these periods to birth size and shape. The data in this study included serial prenatal ultrasounds performed on 1,349 high-risk Scandinavian women enrolled in the National Institute of Child Health and Human Development Study of Successive Small for Gestational Age Births. Fetal growth velocity between ultrasounds was used to identify periods of isolated FGR, and these were studied in relation to anthropometry at birth. FGR was identified in 184 subjects. A control group of 384 subjects without FGR was also identified. Infants with first-trimester FGR (n = 20) had the highest birth weight, ponderal index, and subscapular skinfold thickness. Infants with second-trimester FGR (n = 37) had the highest arm fat percentage. Infants with early third-trimester FGR (n = 55) had the lowest mean birth weight and ponderal index. When infant gender, gestational age, maternal body mass index, and smoking were controlled, birth weight was predicted only by third-trimester FGR (not first- or second-trimester FGR), and arm fat percent was predicted only by second-trimester FGR. These results suggest that birth weight is not a valid indicator of FGR occurring before the third trimester. Body composition may be a more sensitive marker of early FGR.
健康与疾病的发育起源假说表明，胎儿生长受限（FGR）是成年期几种慢性疾病的危险因素。然而，大多数支持性研究使用出生体重作为FGR的替代指标。为了研究出生体重与FGR之间的关系，本研究采用系列产前超声来识别孕期FGR的时期，并将这些时期与出生时的大小和形状相关联。本研究的数据包括对1349名参与美国国立儿童健康与人类发展研究所连续小于胎龄儿出生研究的高危斯堪的纳维亚女性进行的系列产前超声检查。超声检查之间的胎儿生长速度用于识别孤立性FGR的时期，并将其与出生时的人体测量学进行研究。在184名受试者中识别出FGR。还确定了384名无FGR的对照组受试者。孕早期FGR的婴儿（n = 20）出生体重、体重指数和肩胛下皮褶厚度最高。孕中期FGR的婴儿（n = 37）手臂脂肪百分比最高。孕晚期早期FGR的婴儿（n = 55）平均出生体重和体重指数最低。当控制婴儿性别、孕周、母亲体重指数和吸烟情况时，出生体重仅由孕晚期FGR预测（而非孕早期或孕中期FGR），手臂脂肪百分比仅由孕中期FGR预测。这些结果表明，出生体重不是孕晚期之前发生的FGR的有效指标。身体成分可能是早期FGR更敏感的标志物。
