Porter Blake, Neely Cherry, Szychowski Jeff, Owen John
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri, Kansas City, Missouri.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama.
Am J Perinatol. 2015 Aug;32(10):968-72. doi: 10.1055/s-0035-1545664. Epub 2015 Mar 2.
This study aims to derive an estimated fetal weight (EFW) formula in macrosomic fetuses, compare its accuracy to the 1986 Hadlock IV formula, and assess whether including maternal diabetes (MDM) improves estimation.
Retrospective review of nonanomalous live-born singletons with birth weight (BWT) ≥ 4 kg and biometry within 14 days of birth. Formula accuracy included: (1) mean error (ME = EFW - BWT), (2) absolute mean error (AME = absolute value of [1]), and (3) mean percent error (MPE, [1]/BWT × 100%). Using loge BWT as the dependent variable, multivariable linear regression produced a macrosomic-specific formula in a "training" dataset which was verified by "validation" data. Formulas specific for MDM were also developed.
Out of the 403 pregnancies, birth gestational age was 39.5 ± 1.4 weeks, and median BWT was 4,240 g. The macrosomic formula from the training data (n = 201) had associated ME = 54 ± 284 g, AME = 234 ± 167 g, and MPE = 1.6 ± 6.2%; evaluation in the validation dataset (n = 202) showed similar errors. The Hadlock formula had associated ME = -369 ± 422 g, AME = 451 ± 332 g, MPE = -8.3 ± 9.3% (all p < 0.0001). Diabetes-specific formula errors were similar to the macrosomic formula errors (all p = NS).
With BWT ≥ 4 kg, the macrosomic formula was significantly more accurate than Hadlock IV, which systematically underestimates fetal/BWT. Diabetes-specific formulas did not improve accuracy. A specific formula should be considered when macrosomia is suspected.
本研究旨在推导巨大胎儿的估计胎儿体重（EFW）公式，将其准确性与1986年的哈德洛克IV公式进行比较，并评估纳入母体糖尿病（MDM）是否能提高估计准确性。
对出生体重（BWT）≥4 kg且在出生后14天内进行生物测量的非畸形活产单胎进行回顾性研究。公式准确性包括：（1）平均误差（ME = EFW - BWT），（2）绝对平均误差（AME = [1]的绝对值），以及（3）平均百分比误差（MPE，[1]/BWT×100%）。以loge BWT作为因变量，多变量线性回归在一个“训练”数据集中生成了一个巨大胎儿特异性公式，并通过“验证”数据进行验证。还开发了针对MDM的特定公式。
在403例妊娠中，出生孕周为39.5±1.4周，BWT中位数为4240 g。训练数据（n = 201）得出的巨大胎儿公式相关的ME = 54±284 g，AME = 234±167 g，MPE = 1.6±6.2%；在验证数据集（n = 202）中的评估显示了类似的误差。哈德洛克公式相关的ME = -369±422 g，AME = 451±332 g，MPE = -8.3±9.3%（所有p < 0.0001）。糖尿病特异性公式的误差与巨大胎儿公式的误差相似（所有p = 无显著性差异）。
当BWT≥4 kg时，巨大胎儿公式比哈德洛克IV公式显著更准确，后者系统性地低估了胎儿体重/BWT。糖尿病特异性公式并未提高准确性。当怀疑有巨大胎儿时应考虑使用特定公式。
