Rashid Harunor, Ma Enbo, Ferdous Farzana, Ekström Eva-Charlotte, Wagatsuma Yukiko
International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
PLoS One. 2017 Jul 21;12(7):e0181967. doi: 10.1371/journal.pone.0181967. eCollection 2017.
Fetal growth restriction in early pregnancy increases the risk of adverse pregnancy outcome, which has a significant social and psychological impact on women. There is limited information related to community-based study to evaluate early indicators related to miscarriage. The aim of this study is to examine the relationship between fetal growth restriction, measured by ultrasound crown-rump length (CRL), and subsequent occurrence of miscarriage in pregnant women in rural Bangladesh. The study was conducted within the Maternal and Infant Nutrition Interventions Trial in Matlab (MINIMat study), Bangladesh. A total of 4436 pregnant women were enrolled in the study when they were at less than 14 gestational weeks. The expected CRL was determined based on an established growth curve of gestational age and CRL, and deviation from this curve of CRL was expressed as a z-score. After identifying related covariates, the multiple Poisson regression model was used to determine the independent contribution from the CRL to miscarriage. A total of 3058 singleton pregnant women were included in analyses, with 92 miscarriages and 2966 continued pregnancies. The occurrence of miscarriages was significantly higher in the smaller categories of CRL z-score after adjustments for maternal age, parity, early pregnancy BMI, gestational age at CRL measurement and socioeconomic status (adjusted relative risk [95% confidence interval]: 1.03 [1.02-1.05] for less than -2 z-score). In a rural Bangladesh population, smaller than expected CRL for the gestational age was related to subsequent miscarriage. Ultrasound biometry information together with careful clinical assessment should provide much needed attention and care for pregnant women.
孕早期胎儿生长受限会增加不良妊娠结局的风险，这对女性有重大的社会和心理影响。关于基于社区的研究以评估与流产相关的早期指标的信息有限。本研究的目的是探讨在孟加拉国农村地区，通过超声头臀长（CRL）测量的胎儿生长受限与孕妇随后发生流产之间的关系。该研究在孟加拉国Matlab的母婴营养干预试验（MINIMat研究）中进行。共有4436名孕妇在妊娠周数小于14周时纳入研究。根据既定的孕周和CRL生长曲线确定预期的CRL，CRL与该曲线的偏差用z评分表示。在确定相关协变量后，使用多重泊松回归模型来确定CRL对流产的独立影响。共有3058名单胎孕妇纳入分析，其中92例流产，2966例继续妊娠。在调整了产妇年龄、产次、孕早期BMI、测量CRL时的孕周和社会经济地位后，CRL z评分较小类别的流产发生率显著更高（小于-2 z评分时，调整后的相对风险[95%置信区间]：1.03[1.02-1.05]）。在孟加拉国农村人口中，孕周对应的CRL小于预期与随后的流产有关。超声生物测量信息以及仔细的临床评估应为孕妇提供急需的关注和护理。
