Salihu Hamisu M, Mbah Alfred K, Alio Amina P, Kirby Russell S
Department of Epidemiology and Biostatistics and Obstetrics and Gynecology, University of South Florida, Tampa Florida, USA.
Obstet Gynecol. 2008 Apr;111(4):935-43. doi: 10.1097/AOG.0b013e31816a4f09.
To assess whether risk for early mortality is increased with recurrent small for gestational age (SGA) compared with nonrecurrent SGA.
We used the Missouri maternally linked cohort data containing births from 1978-1997. We identified mothers according to four categories: 1) appropriate for gestational age (AGA)-AGA: both first and second pregnancies were AGA; 2) AGA-SGA: first pregnancy was AGA, second pregnancy outcome changed to SGA (a switch); 3) SGA-AGA: first pregnancy was SGA, second pregnancy outcome AGA (a switch); 4) SGA-SGA: both first and second pregnancies were SGA. We then compared the success of fetal programming in the second pregnancy with a switch compared with a pregnancy without a switch (AGA-SGA compared with SGA-SGA; and SGA-AGA compared with AGA-AGA). We used neonatal mortality as primary outcome with infant and postneonatal mortality as secondary outcomes.
Appropriate for gestational age infants from a SGA-primed uterus (SGA-AGA switch) had a 19% (odds ratio 1.19; 95% confidence interval 1.11-1.28) and 29% (odds ratio 1.29; 95% confidence interval 1.17-1.42) greater likelihood of infant and neonatal mortality, respectively, when compared with AGA infants from AGA-primed uterus (AGA-AGA; nonswitch). Approximately the same magnitude of risk elevation for neonatal and infant mortality was noted among SGA infants resulting from AGA-primed uterus (a switch) as among SGA infants from SGA-primed uterus (a nonswitch). Overall, the greatest risk of neonatal, infant, and postneonatal mortality was associated with an AGA-SGA switch.
Fetal programming switch in subsequent gestation adversely affects early survival of affected infants compared with those with no change in fetal growth pattern.
评估与非复发性小于胎龄儿（SGA）相比，复发性SGA是否会增加早期死亡风险。
我们使用了密苏里州母婴关联队列数据，其中包含1978年至1997年的出生记录。我们根据四类情况对母亲进行了识别：1）适于胎龄儿（AGA）-AGA：首次和第二次妊娠均为AGA；2）AGA-SGA：首次妊娠为AGA，第二次妊娠结局变为SGA（转变）；3）SGA-AGA：首次妊娠为SGA，第二次妊娠结局为AGA（转变）；4）SGA-SGA：首次和第二次妊娠均为SGA。然后，我们比较了有转变的第二次妊娠与无转变的妊娠（AGA-SGA与SGA-SGA相比；SGA-AGA与AGA-AGA相比）中胎儿编程的成功情况。我们将新生儿死亡率作为主要结局，婴儿死亡率和新生儿后期死亡率作为次要结局。
与来自适于胎龄儿子宫的适于胎龄儿（AGA-AGA；无转变）相比，来自小于胎龄儿预激子宫的适于胎龄儿（SGA-AGA转变）的婴儿死亡率和新生儿死亡率分别高出19%（优势比1.19；95%置信区间1.11-1.28）和29%（优势比1.29；95%置信区间1.17-1.42）。来自适于胎龄儿子宫（转变）的小于胎龄儿中，新生儿和婴儿死亡率的风险升高幅度与来自小于胎龄儿子宫（无转变）的小于胎龄儿大致相同。总体而言，新生儿、婴儿和新生儿后期死亡率的最大风险与AGA-SGA转变相关。
与胎儿生长模式无变化的婴儿相比，后续妊娠中的胎儿编程转变对受影响婴儿的早期生存产生不利影响。
