Departments of Obstetrics and Gynaecology and Public Health and Primary Care, University of Cambridge, and the National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre, Cambridge, and the Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
Obstet Gynecol. 2014 Aug;124(2 Pt 1):274-283. doi: 10.1097/AOG.0000000000000388.
To estimate the association between birth weight percentile and the risk of perinatal death at term in relation to the cause of death.
We performed a retrospective cohort study of all term singleton births in delivery units in Scotland between 1992 and 2008 (n=784,576), excluding perinatal deaths ascribed to congenital anomaly.
There were 1,700 perinatal deaths in the cohort, which were not the result of congenital anomaly (21.7/10,000 women at term). We observed a reversed J-shaped association between birth weight percentile and the risk of antepartum stillbirth in all women, but the associations significantly differed (P<.001) according to smoking status. The highest risk (adjusted odds ratio referent to 21st-80th percentile, 95% confidence interval) among nonsmokers was for birth weight third or less percentile (10.5, 8.2-13.3), but there were also positive associations for birth weight percentiles 4th-10th (3.8, 3.0-4.8), 11th-20th (1.9, 1.5-2.4), and 98th-100th (1.8, 1.3-2.4). Among smokers, the associations with being small were weaker and the associations with being large were stronger. We also observed a reversed J-shaped association between birth weight percentile and the risk of delivery-related perinatal death (ie, intrapartum stillbirth or neonatal death), but there was no interaction with smoking. The highest risk was for birth weight greater than the 97th percentile (2.3, 1.6-3.3), but there were also associations with third or less percentile (2.1, 1.4-3.1), 4th-10th (1.8, 1.4-2.4), and 11th-20th (1.5, 1.2-2.0). Analysis of the attributable fraction indicated that approximately one in three antepartum stillbirths and one in six delivery-related deaths at term could be related to birth weight percentile outside the range 21st-97th percentile.
Effective detection of variation in fetal size at term has potential as a screening test for the risk of perinatal death.
II.
评估出生体重百分位与足月产时围产死亡风险的关系，以及死亡原因。
我们对 1992 年至 2008 年期间苏格兰分娩单位的所有足月单胎出生进行了回顾性队列研究（n=784576），排除了归因于先天性异常的围产儿死亡。
该队列中有 1700 例围产儿死亡，并非先天性异常所致（21.7/10000 名足月女性）。我们观察到，在所有女性中，出生体重百分位与产前死产的风险之间存在反向 J 形关联，但关联差异显著（P<.001），这与吸烟状态有关。不吸烟者中最高的风险（调整后的优势比，参考第 21-80 百分位，95%置信区间）是出生体重第三或更低百分位（10.5，8.2-13.3），但出生体重第 4-10 百分位（3.8，3.0-4.8）、第 11-20 百分位（1.9，1.5-2.4）和第 98-100 百分位（1.8，1.3-2.4）也存在正相关。在吸烟者中，与体型小相关的关联较弱，与体型大相关的关联较强。我们还观察到出生体重百分位与与分娩相关的围产儿死亡（即产时死产或新生儿死亡）风险之间存在反向 J 形关联，但与吸烟无关。最高风险是出生体重大于第 97 百分位（2.3，1.6-3.3），但与第三或更低百分位（2.1，1.4-3.1）、第 4-10 百分位（1.8，1.4-2.4）和第 11-20 百分位（1.5，1.2-2.0）也存在关联。归因分数分析表明，大约三分之一的产前死产和六分之一的与分娩相关的足月死亡可能与第 21-97 百分位以外的出生体重百分位有关。
有效检测足月时胎儿大小的变化可能成为围产儿死亡风险的筛查试验。
II 级。
