胎盘血管血流对出生体重纵向影响中的种族异质性。
Ethnic heterogeneity in the longitudinal effects of placental vascular blood flow on birthweight.
作者信息
Misra Vinod K, Hobel Calvin J, Sing Charles F
机构信息
Division of Medical Genetics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA.
出版信息
Am J Obstet Gynecol. 2008 Jan;198(1):72.e1-8. doi: 10.1016/j.ajog.2007.05.043. Epub 2007 Sep 12.
OBJECTIVE
Our goals were: (1) to estimate the longitudinal trends in uterine artery (UtArt) and umbilical artery (UmArt) resistance indices (RIs) in different ethnic strata; (2) to estimate time-dependent changes across gestation in the influence of variation in UtArt and UmArt RI on variation in birthweight in different ethnic strata; and (3) to determine the optimum set of UtArt and UmArt RIs for predicting birthweight in different ethnic strata.
STUDY DESIGN
Analyses were carried out on data collected in a prospective study of 535 multiethnic gravidas recruited from the Cedars-Sinai Medical Center (Los Angeles, CA). Baseline maternal characteristics were recorded at time of entry into the study. UtArt and UmArt RIs were measured on 3 occasions during pregnancy (visit 1, 16-20 weeks' gestation; visit 2, 21-29 weeks' gestation; and visit 3, 30-36 weeks' gestation). The outcome for this study was gestational age-adjusted birthweight (aBW).
RESULTS
The average UtArt and UmArt RI decreased steadily across gestation for all ethnicities. The average UtArt RI at each visit and the average rate of change between visits were not significantly different among the ethnicities. However, the UmArt RI measured at visit 3 and its rate of change in the last trimester were significantly different among the ethnic groups (P < .02). After adjustment for traditional risk factors for fetal growth restriction, the magnitude and rate of change of UtArt RI significantly predicted aBW only in Hispanic women, whereas the magnitude and rate of change of UmArt RI predicted aBW only in African American women. The most parsimonious combination of UtArt and UmArt RI measurements at visits 1, 2, and 3 that predicted statistically significant variation in aBW differed by ethnicity.
CONCLUSION
The relationships between aBW and longitudinally collected measures of UtArt and UmArt RI depend on the context defined by ethnicity and time of measurement after adjusting for a parsimoniously selected subset of traditional risk factors.
目的
我们的目标是：（1）评估不同种族群体中子宫动脉（UtArt）和脐动脉（UmArt）阻力指数（RI）的纵向变化趋势；（2）评估不同种族群体中，UtArt和UmArt RI的变化对出生体重变化的影响在整个孕期随时间的变化情况；（3）确定不同种族群体中预测出生体重的UtArt和UmArt RI的最佳组合。
研究设计
对从雪松西奈医疗中心（加利福尼亚州洛杉矶）招募的535名多民族孕妇的前瞻性研究数据进行分析。在进入研究时记录孕妇的基线特征。在孕期3个时间点测量UtArt和UmArt RI（第1次访视，孕16 - 20周；第2次访视，孕21 - 29周；第3次访视，孕30 - 36周）。本研究的结局指标是孕周校正出生体重（aBW）。
结果
所有种族群体中，UtArt和UmArt RI的平均值在整个孕期均稳步下降。各次访视时UtArt RI的平均值及访视间的平均变化率在不同种族群体中无显著差异。然而，第3次访视时测量的UmArt RI及其在孕晚期的变化率在不同种族群体中有显著差异（P <.02）。在调整胎儿生长受限的传统危险因素后，UtArt RI的大小和变化率仅在西班牙裔女性中显著预测aBW，而UmArt RI的大小和变化率仅在非裔美国女性中预测aBW。预测aBW有统计学显著差异的UtArt和UmArt RI测量值在第1、2、3次访视时的最简约组合因种族而异。
结论
在调整了经过简约选择的传统危险因素子集后，aBW与纵向收集的UtArt和UmArt RI测量值之间的关系取决于种族和测量时间所定义的背景。
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