Wallenstein Matthew B, Harper Lorie M, Odibo Anthony O, Roehl Kimberly A, Longman Ryan E, Macones George A, Cahill Alison G
Department of Obstetrics and Gynecology, Washington University in St. Louis, MO, USA.
J Matern Fetal Neonatal Med. 2012 Jun;25(6):662-5. doi: 10.3109/14767058.2011.597900. Epub 2011 Aug 8.
Fetal congenital heart disease may lead to abnormal fetal growth. Our objective was to estimate the association between fetal congenital heart disease (CHD) and intrauterine growth restriction (IUGR) in an effort to better inform clinical management of continuing pregnancies complicated by fetal congenital heart disease.
In a retrospective cohort study, outcome data was collected from singleton pregnancies undergoing routine anatomic survey at a tertiary medical center between 1990 and 2008. Dedicated research nurses collected information on delivery outcomes in an on-going manner. Subjects with a prenatal diagnosis of fetal CHD were compared to those without CHD. Stratified analyses for isolated fetal CHD and major CHD were performed. The primary outcome was IUGR less than 10th percentile by the Alexander growth standard. Logistic regression was used to adjust for confounding variables and refine the estimates of risk.
Among 67,823 patients, there were 193 cases of fetal CHD (0.3%) and 5,669 cases of IUGR (8.4%). Prenatal diagnosis of CHD was associated with an increased risk of IUGR (23.8% vs. 8.5%, adjusted odds ratio [aOR] 3.3, 95% confidence interval [CI] 2.4-4.6), and the risk was greatest in fetuses with major CHD (16.5% vs. 8.5%, aOR 2.1, 95% CI 1.3-3.2). Isolated CHD was also associated with an increased risk of IUGR (17.8% vs. 8.5%, aOR 2.2, 95% CI 1.4-3.7).
Patients with a prenatal diagnosis of fetal CHD have a three-fold increase in risk of developing IUGR; patients with isolated fetal CHD are twice as likely to develop IUGR. Based on our findings, serial growth assessment may be a reasonable option for patients with fetal CHD diagnosed at routine anatomic survey.
胎儿先天性心脏病可能导致胎儿生长异常。我们的目的是评估胎儿先天性心脏病（CHD）与宫内生长受限（IUGR）之间的关联，以便为临床处理合并胎儿先天性心脏病的继续妊娠提供更好的依据。
在一项回顾性队列研究中，收集了1990年至2008年期间在一家三级医疗中心接受常规解剖学检查的单胎妊娠的结局数据。专业研究护士持续收集分娩结局信息。将产前诊断为胎儿CHD的受试者与未患CHD的受试者进行比较。对孤立性胎儿CHD和主要CHD进行分层分析。主要结局是按照亚历山大生长标准低于第10百分位数的IUGR。使用逻辑回归调整混杂变量并完善风险估计。
在67,823例患者中，有193例胎儿CHD（0.3%）和5,669例IUGR（8.4%）。CHD的产前诊断与IUGR风险增加相关（23.8%对8.5%，调整优势比[aOR]3.3，95%置信区间[CI]2.4–4.6），且在患有主要CHD的胎儿中风险最高（16.5%对8.5%，aOR 2.1，95%CI 1.3–3.2）。孤立性CHD也与IUGR风险增加相关（17.8%对8.5%，aOR 2.2，95%CI 1.4–3.7）。
产前诊断为胎儿CHD的患者发生IUGR的风险增加两倍；孤立性胎儿CHD患者发生IUGR的可能性是两倍。基于我们的研究结果，对于在常规解剖学检查中诊断出胎儿CHD的患者，连续生长评估可能是一个合理的选择。
