个体化的胎儿最佳生长规范：胎儿生长潜能

Individualized norms of optimal fetal growth: fetal growth potential.

作者信息

Bukowski Radek, Uchida Tatsuo, Smith Gordon C S, Malone Fergal D, Ball Robert H, Nyberg David A, Comstock Christine H, Hankins Gary D V, Berkowitz Richard L, Gross Susan J, Dugoff Lorraine, Craigo Sabrina D, Timor Ilan E, Carr Stephen R, Wolfe Honor M, D'Alton Mary E

机构信息

Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas 77555, USA.

出版信息

Obstet Gynecol. 2008 May;111(5):1065-76. doi: 10.1097/AOG.0b013e3181704e48.

DOI:10.1097/AOG.0b013e3181704e48

PMID:18448737

Abstract

OBJECTIVE

To demonstrate that individualized optimal fetal growth norms, accounting for physiologic and pathologic determinants of fetal growth, better identify normal and abnormal outcomes of pregnancy than existing methods.

METHODS

In a prospective cohort of 38,033 singleton pregnancies, we identified 9,818 women with a completely normal outcome of pregnancy and characterized the physiologic factors affecting birth weight using multivariable regression. We used those physiologic factors to individually predict optimal growth trajectory and its variation, growth potential, for each fetus in the entire cohort. By comparing actual birth weight with growth potential, population, ultrasound, and customized norms, we calculated for each fetus achieved percentiles, by each norm. We then compared proportions of pregnancies classified as normally grown, between 10th and 90th percentile, or aberrantly grown, outside this interval, by growth potential and traditional norms, in 14,229 complicated pregnancies, 1,518 pregnancies with diabetes or hypertensive disorders, and 1,347 pregnancies with neonatal complications.

RESULTS

Nineteen physiologic factors, associated with maternal characteristics and early placental function, were identified. Growth potential norms correctly classified significantly more pregnancies than population, ultrasound, or customized norms in complicated pregnancies (26.4% compared with 18.3%, 18.7%, 22.8%, respectively, all P<.05), pregnancies with diabetes or hypertensive disorders (37.3% compared with 23.0%, 28.0%, 34.0%, respectively, all P<.05) and neonatal complications (33.3% compared with 19.7%, 24.9%, 29.8%, respectively, all P<.05).

CONCLUSION

Growth potential norms based on the physiologic determinants of birth weight are a better discriminator of aberrations of fetal growth than traditional norms.

LEVEL OF EVIDENCE

II.

摘要

目的

证明考虑胎儿生长的生理和病理决定因素的个体化最佳胎儿生长标准，比现有方法能更好地识别正常和异常妊娠结局。

方法

在一个有38033例单胎妊娠的前瞻性队列中，我们识别出9818例妊娠结局完全正常的女性，并使用多变量回归分析来描述影响出生体重的生理因素。我们利用这些生理因素分别预测整个队列中每个胎儿的最佳生长轨迹及其变化，即生长潜能。通过将实际出生体重与生长潜能、总体标准、超声标准和定制标准进行比较，我们计算出每个胎儿按照每种标准所达到的百分位数。然后，我们比较了在14229例复杂妊娠、1518例患有糖尿病或高血压疾病的妊娠以及1347例有新生儿并发症的妊娠中，根据生长潜能标准和传统标准分类为正常生长（第10至90百分位数之间）或异常生长（此区间之外）的妊娠比例。

结果

确定了19个与母亲特征和早期胎盘功能相关的生理因素。在复杂妊娠中，生长潜能标准正确分类的妊娠显著多于总体标准、超声标准或定制标准（分别为26.4%，而总体标准为18.3%、超声标准为18.7%、定制标准为22.8%，均P<0.05）；在患有糖尿病或高血压疾病的妊娠中（分别为37.3%，而总体标准为23.0%、超声标准为28.0%、定制标准为34.0%，均P<0.05）；以及在有新生儿并发症的妊娠中（分别为33.3%，而总体标准为19.7%、超声标准为24.9%、定制标准为29.8%，均P<0.05）。