中孕期至晚孕期的纵向生长评估预测小于胎龄儿及早产儿生长受限。

Second- to third-trimester longitudinal growth assessment for prediction of small-for-gestational age and late fetal growth restriction.

机构信息

Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain.

Fetal Medicine Unit, Clínica Dávila, Santiago, Chile.

出版信息

Ultrasound Obstet Gynecol. 2018 Feb;51(2):219-224. doi: 10.1002/uog.17471. Epub 2018 Jan 8.

DOI:10.1002/uog.17471

PMID:28332335

Abstract

OBJECTIVE

Detection of fetal growth restriction (FGR) remains poor and most screening strategies rely on cross-sectional evaluation of fetal size during the third trimester. A longitudinal and individualized approach has been proposed as an alternative method of evaluation. The aim of this study was to compare second- to third-trimester longitudinal growth assessment to cross-sectional evaluation in the third trimester for the prediction of small-for-gestational age (SGA) and late FGR in low-risk singleton pregnancy.

METHODS

This was a prospective cohort study of 2696 unselected consecutive low-risk singleton pregnancies scanned at 21 ± 2 and 32 ± 2 weeks. For cross-sectional growth assessment, abdominal circumference (AC) measurements were transformed to z-values according the 21st-INTERGROWTH standards. Longitudinal growth assessment was performed by calculating the AC z-velocity and the second- to third-trimester AC conditional growth centile. Longitudinal assessment was compared with cross-sectional assessment at 32 weeks. Association of cross-sectional and longitudinal evaluations with SGA and late FGR was assessed by logistic regression analysis. Predictive performance was determined by receiver-operating characteristics curve analysis.

RESULT

In total, 210 (7.8%) newborns were classified as SGA and 103 (3.8%) as late FGR. Neither longitudinal measurement improved the association with SGA or late FGR provided by cross-sectional evaluation of AC z-score at 32 weeks. Areas under the curves of AC z-velocity and conditional AC growth were significantly smaller than those of cross-sectional AC z-scores (P < 0.001), although AC z-velocity performed significantly better than did conditional AC growth (P < 0.001).

CONCLUSION

Longitudinal assessment of fetal growth from the second to third trimester has a low predictive capacity for SGA and late FGR in low-risk singleton pregnancy compared with cross-sectional growth evaluation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

摘要

目的

胎儿生长受限（FGR）的检测仍然不理想，大多数筛查策略依赖于孕晚期胎儿大小的横断面评估。已经提出了一种纵向和个体化的方法作为替代评估方法。本研究的目的是比较孕中期至孕晚期的纵向生长评估与孕晚期的横断面评估，以预测低危单胎妊娠的小于胎龄儿（SGA）和晚期 FGR。

方法

这是一项前瞻性队列研究，共纳入 2696 例未经选择的连续低危单胎妊娠，在 21±2 周和 32±2 周进行扫描。对于横断面生长评估，根据 21 世纪 INTERGROWTH 标准，将腹围（AC）测量值转换为 z 值。纵向生长评估通过计算 AC z 速度和孕中期至孕晚期 AC 条件生长百分位数来进行。将纵向评估与 32 周时的横断面评估进行比较。通过逻辑回归分析评估横断面和纵向评估与 SGA 和晚期 FGR 的相关性。通过接受者操作特征曲线分析确定预测性能。

结果

共有 210 例（7.8%）新生儿被归类为 SGA，103 例（3.8%）为晚期 FGR。纵向测量均未改善 32 周时 AC z 评分的横断面评估与 SGA 或晚期 FGR 的相关性。AC z 速度和条件 AC 生长的曲线下面积明显小于横断面 AC z 评分（P<0.001），尽管 AC z 速度的表现明显优于条件 AC 生长（P<0.001）。