Dotters-Katz Sarah K, Humphrey Whitney M, Senz Kayli L, Lee Vanessa R, Shaffer Brian L, Caughey Aaron B
Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, Oregon.
Am J Perinatol. 2016 Oct;33(12):1152-8. doi: 10.1055/s-0036-1585083. Epub 2016 Jul 1.
Objective This study aims to evaluate the perinatal and neonatal outcomes associated with prenatal diagnosis of 45,X, both with and without fetal cardiac anomalies. Study Design A retrospective cohort of singleton pregnancies in California, 2005 to 2008, using vital statistics and International Classification of Diseases, Ninth Revision data, identifying prenatally diagnosed 45,X. Outcomes included preterm delivery, preeclampsia, intrauterine fetal demise (IUFD), cesarean section, small for gestational age (SGA), neonatal death, and infant death. Bivariate and multivariate analyses were used to compare pregnancies and neonates with and without 45,X. Prenatally diagnosed cardiac anomalies were also considered. Results Of the 2,029,000 deliveries, 138 had prenatally diagnosed 45,X. Out of these 138 deliveries, 22 had a prenatally diagnosed cardiac anomaly. Compared with unaffected pregnancies, those with fetal 45,X had higher rates of preterm delivery (19.5 vs. 9.9%, p = 0.001), cesarean section (44.2 vs. 30.2%, p < 0.0001), and SGA (21.5 vs. 6.3%, p < 0.0001). The affected cohort had no IUFDs. Neonatal death was 14.5 times higher in the 45,X cohort (p < 0.0001). Of only infants with cardiac anomalies, neonatal death was significantly more likely in those with 45,X (p = 0.005). In adjusted analysis, risk of SGA (< 3rd percentile), neonatal death, and infant death remained increased for infants with 45,X while controlling for fetal cardiac anomalies. Conclusion Prenatally diagnosed 45,X was associated with increased risk of cesarean section, and adverse neonatal outcomes, including mortality.
目的 本研究旨在评估与产前诊断为45,X相关的围产期和新生儿结局，包括有无胎儿心脏异常的情况。研究设计 对2005年至2008年加利福尼亚州的单胎妊娠进行回顾性队列研究，利用生命统计数据和国际疾病分类第九版数据，确定产前诊断为45,X的病例。结局包括早产、子痫前期、宫内胎儿死亡（IUFD）、剖宫产、小于胎龄儿（SGA）、新生儿死亡和婴儿死亡。采用双变量和多变量分析比较有无45,X的妊娠和新生儿情况。还考虑了产前诊断的心脏异常。结果 在2,029,000例分娩中，138例产前诊断为45,X。在这138例分娩中，22例产前诊断有心脏异常。与未受影响的妊娠相比，胎儿为45,X的妊娠早产率更高（19.5%对9.9%，p = 0.001）、剖宫产率更高（44.2%对30.2%，p < 0.0001）和SGA发生率更高（21.5%对6.3%，p < 0.0001）。受影响的队列中没有IUFD。45,X队列中的新生儿死亡率高14.5倍（p < 0.0001）。仅在有心脏异常的婴儿中，45,X的婴儿发生新生儿死亡的可能性显著更高（p = 0.005）。在调整分析中，在控制胎儿心脏异常的情况下，45,X婴儿的SGA（<第3百分位数）、新生儿死亡和婴儿死亡风险仍然增加。结论 产前诊断为45,X与剖宫产风险增加以及包括死亡率在内的不良新生儿结局相关。
