Deter Russell L, Lee Wesley, Kingdom John, Romero Roberto
a Department of Obstetrics and Gynecology , Texas Children's Hospital, Baylor College of Medicine , Houston , TX , USA.
b Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research , Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda , MD and Detroit , MI , USA.
J Matern Fetal Neonatal Med. 2019 Mar;32(6):939-946. doi: 10.1080/14767058.2017.1395849. Epub 2017 Nov 7.
To evaluate the validity of second trimester growth velocities as measures of fetal growth potential in Small-for-Gestational-Age (SGA) singletons.
Second trimester growth velocities for biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FDL) were determined by linear regression analysis or direct measurement in 53 SGA singletons with normal growth outcomes (SGA N Group) and 73 with growth restriction (SGA GR) based on a composite fetal growth pathology score (FGPS1). The latter were subdivided into six groups based on their growth restriction pattern (Patterns group). Similar data were available for 118 singletons with normal neonatal growth outcomes (NNGO group). Coefficients of determination (R) and growth velocities for each anatomical parameter were compared between Patterns subgroups and the SGA N, SGA GR and NNGO groups.
Median R values in the six Patterns subgroups ranged from 98.2% (Pattern 2, FDL) to 99.9% (Pattern 5, AC). Within each anatomical parameter set, no significant differences were found (Kruskal-Wallis). Patterns subgroup data were pooled to form the SGA GR group for each anatomical parameter. Mean values for the three main groups ranged from 98.4% (SGA N, FDL) to 99.6% (SGA N, HC). No significant differences between groups (ANOVA) were found for any anatomical parameter (ANOVA). Only 1.7-3.8% had R values <95th%. No significant differences in median second trimester growth velocities among different Patterns subgroups were found for any anatomical parameter. In the SGA N and SGA GR groups, mean BPD and HC values did not differ but were significantly smaller than the NNGO group values. No differences in mean FDL values were seen. With AC, all three means were significantly different, having the following order: NNGO > SGA N > SGA GR. Of all 504 second trimester growth rates, 92.5% were within their respective 95% reference ranges.
Growth in the second trimester is linear in fetuses at risk for growth restriction. Except for FDL, growth velocities were lower than those for fetuses with NNGO. Only AC had mean velocities that differed between the SGA N and the SGA GR groups. Since most velocities (92.5%) were within normal reference ranges, they are reasonable measures of growth potential in fetuses at risk for growth restriction.
评估孕中期生长速度作为小于胎龄（SGA）单胎胎儿生长潜能指标的有效性。
通过线性回归分析或直接测量，确定了53例生长结局正常的SGA单胎（SGA N组）和73例基于综合胎儿生长病理评分（FGPS1）存在生长受限的SGA单胎（SGA GR组）的孕中期双顶径（BPD）、头围（HC）、腹围（AC）和股骨干长度（FDL）的生长速度。后者根据其生长受限模式分为六个组（模式组）。118例新生儿生长结局正常的单胎（NNGO组）也有类似数据。比较了模式亚组与SGA N组、SGA GR组和NNGO组之间各解剖参数的决定系数（R）和生长速度。
六个模式亚组的中位数R值范围为98.2%（模式2，FDL）至99.9%（模式5，AC）。在每个解剖参数组内，未发现显著差异（Kruskal-Wallis检验）。将模式亚组数据合并形成每个解剖参数的SGA GR组。三个主要组的平均值范围为98.4%（SGA N组，FDL）至99.6%（SGA N组，HC）。对于任何解剖参数，各组之间均未发现显著差异（方差分析）。只有1.7 - 3.8%的R值<第95百分位数。对于任何解剖参数，不同模式亚组之间的孕中期生长速度中位数均未发现显著差异。在SGA N组和SGA GR组中，平均BPD和HC值无差异，但显著小于NNGO组的值。FDL平均值未见差异。对于AC，三个平均值均有显著差异，顺序如下：NNGO＞SGA N＞SGA GR。在所有504个孕中期生长率中，92.5%在各自的95%参考范围内。
生长受限风险胎儿在孕中期的生长呈线性。除FDL外，生长速度低于新生儿生长结局正常的胎儿。只有AC在SGA N组和SGA GR组之间的平均速度存在差异。由于大多数速度（92.5%）在正常参考范围内，它们是生长受限风险胎儿生长潜能的合理指标。
