足月出生于无并发症妊娠的小于胎龄儿和大于胎龄儿的新生儿发病率。
Neonatal Morbidity of Small- and Large-for-Gestational-Age Neonates Born at Term in Uncomplicated Pregnancies.
作者信息
Chauhan Suneet P, Rice Madeline Murguia, Grobman William A, Bailit Jennifer, Reddy Uma M, Wapner Ronald J, Varner Michael W, Thorp John M, Leveno Kenneth J, Caritis Steve N, Prasad Mona, Tita Alan T N, Saade George, Sorokin Yoram, Rouse Dwight J, Tolosa Jorge E
机构信息
Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas, Northwestern University, Chicago, Illinois, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, Columbia University, New York, New York, the University of Utah Health Sciences Center, Salt Lake City, Utah, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, the University of Texas Southwestern Medical Center, Dallas, Texas, the University of Pittsburgh, Pittsburgh, Pennsylvania, The Ohio State University, Columbus, Ohio, the University of Alabama at Birmingham, Birmingham, Alabama, the University of Texas Medical Branch, Galveston, Texas, Wayne State University, Detroit, Michigan, Brown University, Providence, Rhode Island, and Oregon Health & Science University, Portland, Oregon; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
出版信息
Obstet Gynecol. 2017 Sep;130(3):511-519. doi: 10.1097/AOG.0000000000002199.
OBJECTIVE
To compare morbidity among small-for-gestational-age (SGA; birth weight less than the 10th percentile for gestational age), appropriate-for-gestational-age (AGA; birth weight 10th to 90th percentile; reference group), and large-for-gestational-age (LGA; birth weight greater than the 90th percentile) neonates in apparently uncomplicated pregnancies at term (37 weeks of gestation or greater).
METHODS
This secondary analysis, derived from an observational obstetric cohort of 115,502 deliveries, included women with apparently uncomplicated pregnancies of nonanomalous singletons who had confirmatory ultrasound dating no later than the second trimester and who delivered between 37 0/7 and 42 6/7 weeks of gestation. We used two different composite neonatal morbidity outcomes: hypoxic composite neonatal morbidity for SGA and traumatic composite neonatal morbidity for LGA neonates. Log Poisson relative risks (RRs) with 95% CIs adjusted for potential confounding factors (nulliparity, body mass index, insurance status, and neonatal sex) were calculated.
RESULTS
Among the 63,436 women who met our inclusion criteria, SGA occurred in 7.9% (n=4,983) and LGA in 8.3% (n=5,253). Hypoxic composite neonatal morbidity was significantly higher in SGA (1.1%) compared with AGA (0.7%; adjusted RR 1.44, 95% CI 1.07-1.93) but similar between LGA (0.6%) and AGA (adjusted RR 0.84, 95% CI 0.58-1.22). Traumatic composite neonatal morbidity was significantly higher in LGA (1.9%) than AGA (1.0%; adjusted RR 1.88, 95% CI 1.51-2.34) but similar in SGA (1.3%) compared with AGA (adjusted RR 1.28, 95% CI 0.98-1.67).
CONCLUSION
Among women with uncomplicated pregnancies, hypoxic composite neonatal morbidity is more common with SGA neonates and traumatic-composite neonatal morbidity is more common with LGA neonates.
目的
比较足月（妊娠37周及以上）单胎妊娠且无明显并发症的小于胎龄儿（SGA；出生体重低于同孕周第10百分位数）、适于胎龄儿（AGA；出生体重在同孕周第10至90百分位数之间；参照组）和大于胎龄儿（LGA；出生体重高于同孕周第90百分位数）新生儿的发病率。
方法
这项二次分析源自一个包含115,502例分娩的产科观察队列，纳入了单胎妊娠且无明显并发症、孕中期超声确诊孕周且妊娠37 0/7至42 6/7周分娩的女性。我们使用了两种不同的综合新生儿发病结局：SGA的缺氧性综合新生儿发病率和LGA新生儿的创伤性综合新生儿发病率。计算了校正潜在混杂因素（初产、体重指数、保险状况和新生儿性别）后的对数泊松相对风险（RRs）及95%置信区间（CIs）。
结果
在符合纳入标准的63,436名女性中，SGA发生率为7.9%（n = 4,983），LGA发生率为8.3%（n = 5,253）。SGA的缺氧性综合新生儿发病率（1.1%）显著高于AGA（0.7%；校正RR 1.44，95% CI 1.07 - 1.93），但LGA（0.6%）与AGA相似（校正RR 0.84，95% CI 0.58 - 1.22）。LGA的创伤性综合新生儿发病率（1.9%）显著高于AGA（1.0%；校正RR 1.88，95% CI 1.51 - 2.34），但SGA（1.3%）与AGA相似（校正RR 1.28，95% CI 0.98 - 1.67）。
结论
在无并发症的妊娠女性中，SGA新生儿更易发生缺氧性综合新生儿疾病，LGA新生儿更易发生创伤性综合新生儿疾病。
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