Am J Epidemiol. 2013 Oct 15;178(8):1301-8. doi: 10.1093/aje/kwt176. Epub 2013 Aug 21.
Customized birth weight charts that incorporate maternal characteristics are now being adopted into clinical practice. However, there is controversy surrounding the value of these charts in the prediction of growth and perinatal outcomes. The objective of this study was to assess the use of customized charts in predicting growth, defined by body fat percentage, and perinatal morbidity. A total of 581 term (≥37 weeks' gestation) neonates born in Sydney, Australia, in 2010 were included. Body fat percentage measurements were taken by using air displacement plethysmography. Objective composite measurements of perinatal morbidity were used to identify neonates who had poor outcomes; these data were extracted from medical records. The value of customized charts was assessed by calculating positive predictive values, negative predictive values, and odds ratios with 95% confidence intervals. Customized versus population-based charts did not improve the prediction of either low body fat percentage (59% vs. 66% positive predictive value and 87% vs. 89% negative predictive value, respectively) or high body fat percentage (48% vs. 53% positive predictive value and 90% vs. 89% negative predictive value, respectively). Customized charts were not better than population-based charts at predicting perinatal morbidity (for customized charts, odds ratio = 1.02, 95% confidence interval: 1.01, 1.04; for population-based charts, odds ratio = 1.03, 95% confidence interval: 1.01, 1.05) per percentile decrease in birth weight. Customized birth weight charts do not provide significant improvements over population-based charts in predicting neonatal growth and morbidity.
目前，临床实践中已采用纳入产妇特征的定制化出生体重图表。然而，这些图表在预测生长和围产期结局方面的价值仍存在争议。本研究旨在评估定制图表在预测通过体脂百分比定义的生长和围产期发病率方面的使用情况。2010 年，澳大利亚悉尼共纳入 581 例足月（≥37 周妊娠）新生儿。采用空气置换体积描记法测量体脂百分比。使用客观复合围产期发病率测量来识别不良结局的新生儿；这些数据从病历中提取。通过计算阳性预测值、阴性预测值和优势比及其 95%置信区间来评估定制图表的价值。定制图表与基于人群的图表相比，并未改善低体脂百分比（阳性预测值分别为 59%与 66%，阴性预测值分别为 87%与 89%）或高体脂百分比（阳性预测值分别为 48%与 53%，阴性预测值分别为 90%与 89%）的预测效果。在预测围产期发病率方面，定制图表并不优于基于人群的图表（对于定制图表，比值比=1.02，95%置信区间：1.01，1.04；对于基于人群的图表，比值比=1.03，95%置信区间：1.01，1.05），即出生体重每降低一个百分位。定制出生体重图表在预测新生儿生长和发病率方面并未优于基于人群的图表。
