母亲 BMI 对 FaSTER 试验中遗传超声的影响。

Influence of maternal BMI on genetic sonography in the FaSTER trial.

机构信息

University of Utah, Salt Lake City, UT, USA.

出版信息

Prenat Diagn. 2010 Jan;30(1):14-22. doi: 10.1002/pd.2399.

DOI:10.1002/pd.2399

PMID:19918963

Abstract

OBJECTIVE

We sought to evaluate the influence of maternal body mass index (BMI) on sonographic detection employing data from the FaSTER trial.

METHOD

Unselected singleton pregnancies underwent detailed genetic sonogram to evaluate for structural fetal anomalies and soft markers for aneuploidy. BMI (kg/m(2)) were calculated from reported initial visit values. Sensitivity, specificity, false positive and false negative rates (FPR and FNR), likelihood ratio, detection rates, and a missed diagnosis rate (MDR: FNR + marker recorded as 'missing'/N) were calculated.

RESULTS

Eight thousand five hundred and fifty-five patients with complete BMI information had detailed genetic sonography. A lower sensitivity with an elevated FNR and MDR was observed in obese women for multiple aneuploid markers (e.g. > or =2 markers 32% sensitivity with 68% FNR among BMI <25 vs 22% and 78% among BMI >30). Similarly, the detection rate for cardiac anomalies among women at BMI <25 was higher (21.6%) at a significantly lower FPR (78.4%; 95% CI 77.3-79.5%) in comparison to obese women (8.3% with FPR 91.7%; 95% CI 90.1-93.2%). In a logistic regression model, maternal obesity significantly decreased the likelihood of sonographic detection of common anomalies (adjusted OR 0.7; 95% CI 0.6-0.9; p = 0.001).

CONCLUSION

The performance of second trimester genetic sonography is influenced by obesity, with a significantly higher MDR for multiple minor markers and lower likelihood for detecting common anomalies.

摘要

目的

我们试图利用 FaSTER 试验的数据评估母体体重指数（BMI）对超声检测的影响。

方法

未经选择的单胎妊娠接受详细的基因超声检查，以评估结构胎儿异常和非整倍体的软标记物。BMI（kg/m2）是根据报告的初始就诊值计算得出的。计算了灵敏度、特异性、假阳性率和假阴性率（FPR 和 FNR）、似然比、检出率和漏诊率（MDR：FNR +标记物记录为“缺失”/N）。

结果

8555 名具有完整 BMI 信息的患者接受了详细的基因超声检查。对于多个非整倍体标志物（例如> = 2 个标志物），肥胖女性的灵敏度较低，FNR 和 MDR 较高（BMI < 25 时的灵敏度为 32%，FNR 为 68%，而 BMI > 30 时的灵敏度为 22%，FNR 为 78%）。同样，BMI < 25 的女性心脏异常的检出率较高（21.6%），FPR 明显较低（78.4%；95%CI 77.3-79.5%），而肥胖女性的检出率较低（8.3%，FPR 为 91.7%；95%CI 90.1-93.2%）。在逻辑回归模型中，母亲肥胖显著降低了超声检测常见异常的可能性（调整后的 OR 为 0.7；95%CI 0.6-0.9；p = 0.001）。