Carberry Angela E, Gordon Adrienne, Bond Diana M, Hyett Jon, Raynes-Greenow Camille H, Jeffery Heather E
Sydney School of Public Health, University of Sydney, Camperdown, Sydney, NSW, Australia, 2050.
Cochrane Database Syst Rev. 2014 May 16;2014(5):CD008549. doi: 10.1002/14651858.CD008549.pub3.
Fetal growth restriction is defined as failure to reach growth potential and considered one of the major complications of pregnancy. These infants are often, although not universally, small for gestational age (SGA). SGA is defined as a weight less than a specified percentile (usually the 10th percentile). Identification of SGA infants is important because these infants are at increased risk of perinatal morbidity and mortality. Screening for SGA is a challenge for all maternity care providers and current methods of clinical assessment fail to detect many infants who are SGA. Large observational studies suggest that customised growth charts may be better able to differentiate between constitutional and pathologic smallness. Customised charts adjust for physiological variables such as maternal weight and height, ethnicity and parity.
To assess the benefits and harms of using population-based growth charts compared with customised growth charts as a screening tool for detection of fetal growth in pregnant women.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (12 March 2014), reviewed published guidelines and searched the reference lists of review articles.
Randomised, quasi-randomised or cluster-randomised clinical trials comparing customised versus population-based growth charts used as a screening tool for detection of fetal growth in pregnant women.
Two review authors independently assessed trials for inclusion.
No randomised trials met the inclusion criteria.
AUTHORS' CONCLUSIONS: There is no randomised trial evidence currently available. Further randomised trials are required to accurately assess whether the improvement in detection shown is secondary to customised charts alone or an effect of the policy change. Future research in large trials is needed to investigate the benefits and harms (including perinatal mortality) of using customised growth charts in different settings and for both fundal height and ultrasound measurements.
胎儿生长受限被定义为未能达到生长潜能，被认为是妊娠的主要并发症之一。这些婴儿虽然并非普遍如此，但通常出生体重低于孕周正常水平（小于胎龄儿，SGA）。小于胎龄儿被定义为体重低于特定百分位数（通常为第10百分位数）。识别小于胎龄儿很重要，因为这些婴儿围产期发病和死亡风险增加。对所有产科护理人员来说，筛查小于胎龄儿都是一项挑战，目前的临床评估方法无法检测出许多小于胎龄儿。大型观察性研究表明，定制生长图表可能更能区分体质性和病理性矮小。定制图表会根据诸如孕妇体重和身高、种族及产次等生理变量进行调整。
评估使用基于人群的生长图表与定制生长图表作为筛查工具来检测孕妇胎儿生长情况的利弊。
我们检索了Cochrane妊娠与分娩组试验注册库（2014年3月12日），查阅了已发表的指南，并检索了综述文章的参考文献列表。
比较定制生长图表与基于人群的生长图表作为筛查工具来检测孕妇胎儿生长情况的随机、半随机或整群随机临床试验。
两位综述作者独立评估试验是否纳入。
没有随机试验符合纳入标准。
目前尚无随机试验证据。需要进一步进行随机试验，以准确评估所显示的检测改善是仅归因于定制图表还是政策变化的影响。需要开展大型试验的未来研究，以调查在不同环境下使用定制生长图表以及对宫高和超声测量的利弊（包括围产期死亡率）。
