Monier Isabelle, Ancel Pierre-Yves, Ego Anne, Jarreau Pierre-Henri, Lebeaux Cécile, Kaminski Monique, Goffinet François, Zeitlin Jennifer
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; Antoine Beclere Maternity Unit, Department of Obstetrics and Gynaecology, South Paris University Hospitals, AP-HP, Paris, France.
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; URC - CIC P1419, AP-HP, Hôpital Cochin, Paris, France.
Am J Obstet Gynecol. 2017 May;216(5):516.e1-516.e10. doi: 10.1016/j.ajog.2017.02.001. Epub 2017 Feb 8.
Fetal growth restriction is defined using ultrasound parameters during pregnancy or as a low birthweight for gestational age after birth, but these definitions are not always concordant.
The purpose of this study was to investigate fetal and neonatal outcomes based on antenatal vs postnatal assessments of growth restriction.
From the EPIPAGE 2 population-based prospective study of very preterm births in France in 2011, we included 2919 singleton nonanomalous infants 24-31 weeks gestational age. We constituted 4 groups based on whether the infant was suspected with fetal growth restriction during pregnancy and/or was small for gestational age with a birthweight <10th percentile of intrauterine norms by sex: 1) suspected with fetal growth restriction/small for gestational age 2) not suspected with fetal growth restriction/small for gestational age 3) suspected with fetal growth restriction/not small for gestational age and 4) not suspected with fetal growth restriction/not small for gestational age. We estimated relative risks of perinatal mortality and morbidity for these groups adjusting for maternal and neonatal characteristics.
We found that 22.2% of infants were suspected with fetal growth restriction/small for gestational age, that 11.4% infants were not suspected with fetal growth restriction/small for gestational age, that 3.0% infants were suspected with fetal growth restriction/not small for gestational age, and that 63.4% infants were not suspected with fetal growth restriction/not small for gestational age. Compared with infants who were not suspected with fetal growth restriction/not small-for-gestational-age infants, small-for-gestational-age infants suspected and not suspected with fetal growth restriction had higher risks of stillbirth or termination of pregnancy (adjusted relative risk, 2.0 [95% confidence interval, 1.6-2.5] and adjusted relative risk, 2.8 [95% confidence interval, 2.2-3.4], respectively), in-hospital death (adjusted relative risk, 2.8 [95% confidence interval, 2.0-3.7] and adjusted relative risk, 2.0 [95% confidence interval, 1.5-2.8], respectively), and bronchopulmonary dysplasia (adjusted relative risk, 1.3 [95% confidence interval, 1.2-1.4] and adjusted relative risk, 1.3 [95% confidence interval, 1.1-1.4], respectively), but not severe brain lesions. Risks were not increased for infants suspected with fetal growth restriction but not small-for-gestational-age.
Antenatal and postnatal assessments of fetal growth restriction were not concordant for 14% of very preterm infants. In these cases, birthweight appears to be the more relevant parameter for the identification of infants with higher risks of adverse short-term outcomes.
胎儿生长受限可通过孕期超声参数定义，或出生后根据胎龄的低出生体重来定义，但这些定义并非总是一致。
本研究旨在基于产前与产后生长受限评估来调查胎儿及新生儿结局。
从2011年法国基于人群的极早产EPIPAGE 2前瞻性研究中，我们纳入了2919例孕24 - 31周的单胎非畸形婴儿。根据婴儿在孕期是否被怀疑有胎儿生长受限和/或是否为小于胎龄儿（出生体重低于按性别划分的宫内标准的第10百分位数），我们将其分为4组：1）怀疑有胎儿生长受限/小于胎龄儿；2）未怀疑有胎儿生长受限/小于胎龄儿；3）怀疑有胎儿生长受限/非小于胎龄儿；4）未怀疑有胎儿生长受限/非小于胎龄儿。我们在对母亲和新生儿特征进行校正后，估计了这些组围产期死亡率和发病率的相对风险。
我们发现，22.2%的婴儿被怀疑有胎儿生长受限/小于胎龄儿，11.4%的婴儿未被怀疑有胎儿生长受限/小于胎龄儿，3.0%的婴儿被怀疑有胎儿生长受限/非小于胎龄儿，63.4%的婴儿未被怀疑有胎儿生长受限/非小于胎龄儿。与未被怀疑有胎儿生长受限/非小于胎龄儿的婴儿相比，被怀疑和未被怀疑有胎儿生长受限的小于胎龄儿发生死产或终止妊娠的风险更高（校正相对风险分别为2.0 [95%置信区间，1.6 - 2.5]和2.8 [95%置信区间，2.2 - 3.4]），住院死亡风险更高（校正相对风险分别为2.8 [95%置信区间，2.0 - 3.7]和2.0 [95%置信区间，1.5 - 2.8]），支气管肺发育不良风险更高（校正相对风险分别为1.3 [95%置信区间，1.2 - 1.4]和1.3 [95%置信区间，1.1 - 1.4]），但严重脑损伤风险未增加。对于被怀疑有胎儿生长受限但非小于胎龄儿的婴儿，风险并未增加。
对于14%的极早产婴儿，产前和产后对胎儿生长受限的评估不一致。在这些情况下，出生体重似乎是识别短期不良结局风险较高婴儿的更相关参数。
