Talge N M, Holzman C, Senagore P K, Klebanoff M, Fisher R
1Department of Epidemiology, Michigan State University, East Lansing, MI, USA.
2Department of Physiology, Michigan State University, East Lansing, MI, USA.
J Dev Orig Health Dis. 2011 Oct;2(5):280-90. doi: 10.1017/S2040174411000298.
Birth weight for gestational age (BW/GA) has been associated with a risk of adverse health outcomes. Biological indices of pregnancy complications, maternal mid-pregnancy serum biomarkers and placental pathology may shed light on these associations, but at present, they are most often examined as single entities and offer little insight about overlap. In addition, these indices are typically assessed in relation to the extremes of the BW/GA distribution, leaving open the question of how they relate to the entire BW/GA distribution. Addressing issues such as these may help elucidate why postnatal health outcomes vary across the BW/GA continuum. In this study, we focused on a subset of women who participated in the Pregnancy Outcomes and Community Health Study (n = 1371). We examined BW/GA (i.e. gestational age and sex-referenced z-scores) in relation to obstetric complications, second trimester maternal serum screening results and histologic evidence of placental pathology along with maternal demographics, anthropometrics and substance use. In adjusted models, mean reductions in BW/GA z-scores were associated with preeclampsia (β = -0.70, 95% CI -1.04, -0.36), high maternal serum alpha fetoprotein (β = -0.28, 95% CI -0.43, -0.13), unconjugated estriol (β = -0.31/0.5 multiples of the median decrease, 95% CI -0.41, -0.21) and high levels of maternal obstructive vascular pathology in the placenta (β = -0.46, 95% CI -0.67, -0.25). The findings were similar when preterm infants, small-for-gestational age or large-for-gestational age infants were excluded. More research is needed to examine how the factors studied here might directly mediate or mark risk when evaluating the associations between BW/GA and postnatal health outcomes.
出生体重与胎龄比（BW/GA）与不良健康结局风险相关。妊娠并发症的生物学指标、孕中期母体血清生物标志物和胎盘病理学可能有助于揭示这些关联，但目前，它们大多作为单一实体进行研究，对重叠情况的了解甚少。此外，这些指标通常是相对于BW/GA分布的极端情况进行评估的，这就留下了它们如何与整个BW/GA分布相关的问题。解决诸如此类问题可能有助于阐明为什么产后健康结局在BW/GA连续体中存在差异。在本研究中，我们聚焦于参与妊娠结局与社区健康研究的一部分女性（n = 1371）。我们研究了BW/GA（即胎龄和按性别校正的z分数）与产科并发症、孕中期母体血清筛查结果、胎盘病理学的组织学证据以及母体人口统计学、人体测量学和物质使用情况之间的关系。在调整模型中，BW/GA z分数的平均降低与子痫前期（β = -0.70，95%CI -1.04，-0.36）、母体血清甲胎蛋白水平高（β = -0.28，95%CI -0.43，-0.13）、非结合雌三醇（β = -0.31/中位数下降倍数的0.5，95%CI -0.41，-0.21）以及胎盘中母体阻塞性血管病理学水平高（β = -0.46, 95%CI -0.67, -0.25）相关。排除早产儿、小于胎龄儿或大于胎龄儿后，研究结果相似。在评估BW/GA与产后健康结局之间的关联时，需要更多研究来探讨此处研究的因素如何直接介导或标志风险。
