Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Am J Obstet Gynecol. 2014 Jan;210(1):63.e1-63.e11. doi: 10.1016/j.ajog.2013.09.006. Epub 2013 Sep 10.
Using a cohort of 110,447 singleton, term pregnancies, we aimed to validate the previously proposed customized standard of large-for-gestational-age (LGA) birthweight, derive an additional customized LGA model excluding maternal weight, and evaluate the association between differing definitions of customized LGA and perinatal morbidities.
Three customized LGA classifications, in addition to a population-based 90th percentile, were made according to the principals described by Gardosi: (1) customized LGA using Gardosi's previously published coefficients (LGA-Gardosi), (2) customized LGA using coefficients derived by a similar method but from our larger cohort, and (3) derived without customization for maternal weight. Associations between the LGA classifications and various perinatal morbidity outcomes were evaluated.
Coefficients derived here for physiologic and pathologic effects on birthweight were similar to those previously reported by Gardosi. Customized LGA (any method) generally identified more births to younger, nonwhite, nulliparous mothers with female neonates of lower birthweight compared with population-based LGA. Rates of maternal and neonatal morbidity were greatest in births classified by both population-based LGA and customized LGA (any method). However, the model that excluded customization for maternal weight, revealed a greater proportion of women previously unidentified by population-based LGA who were more frequently black (40% vs 25%) and obese (30% vs 5.1%), along with greater rates of shoulder dystocia, neonatal intensive care unit admission and neonatal respiratory complications, than with LGA-Gardosi.
The use of customized methods of defining LGA was not decisively superior compared with population-based LGA, but custom LGA may be improved by modification of the parameters included in customization.
利用 110447 名单胎足月妊娠队列，旨在验证先前提出的大胎龄儿（LGA）出生体重的定制标准，得出一种不包括产妇体重的额外定制 LGA 模型，并评估不同定义的定制 LGA 与围产期发病率之间的关系。
根据 Gardosi 所述原则，对三种定制 LGA 分类进行了除基于人群的第 90 百分位之外的分类：（1）使用 Gardosi 先前发表的系数的定制 LGA（LGA-Gardosi），（2）使用类似方法但来自我们更大队列的系数的定制 LGA，以及（3）不针对产妇体重进行定制的衍生方法。评估了 LGA 分类与各种围产期发病率结果之间的关联。
这里得出的生理和病理对出生体重的影响系数与 Gardosi 先前报告的相似。与基于人群的 LGA 相比，任何方法的定制 LGA 通常会识别出更多年轻、非白人、初产妇，且女性新生儿的出生体重较低。在基于人群的 LGA 和任何方法的定制 LGA 分类的分娩中，产妇和新生儿发病率最高。然而，排除产妇体重定制的模型显示，与基于人群的 LGA 相比，以前未被识别的妇女比例更高，她们更常见的是黑人（40%比 25%）和肥胖（30%比 5.1%），同时肩难产、新生儿重症监护病房入院和新生儿呼吸并发症的发生率也更高。
与基于人群的 LGA 相比，使用定制方法定义 LGA 并没有明显的优势，但通过修改定制中包含的参数，定制 LGA 可能会得到改善。
