Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.
Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
Acta Obstet Gynecol Scand. 2018 Feb;97(2):168-179. doi: 10.1111/aogs.13269. Epub 2017 Dec 20.
The question of whether universal growth charts can be used in multi-ethnic settings is of general interest. The Intergrowth-21st fetal growth and newborn size standards are suggested to represent optimal fetal growth regardless of country origin. Our aim was to examine whether women fulfilling the strict Intergrowth-21st inclusion criteria were healthier, showed less ethnic differences in fetal growth and newborn size, and less adverse perinatal outcomes.
Data were drawn from a population-based multi-ethnic cohort of 823 presumably healthy pregnant women in Oslo, Norway. We assessed differences in fetal and neonatal gestational age specific z-scores and compared maternal health parameters, pregnancy and birth complications between pregnancies fulfilling and not fulfilling the Intergrowth-21st criteria.
Only 21% of pregnancies enrolled in our cohort fulfilled the Intergrowth-21st criteria. Fetal growth deviated substantially from the new standards, in particular for ethnic Europeans. Ethnic differences persisted in pregnancies fulfilling the criteria. In South Asian fetuses, estimated fetal weight was -0.60 SD (95% confidence interval -1.00, -0.20) lower at 24 gestational weeks, and birthweight was -0.62 SD (-0.95, -0.29) lower, compared with ethnic Europeans. Corresponding numbers for Middle-East/North Africans were -0.13 (-0.62, 0.36) and -0.60 (-1.00, -0.20). Maternal health indicators and birth complications were similar in women fulfilling and not fulfilling the criteria, but the relation depended on ethnic origin.
In an urban multi-ethnic Norwegian population, applying an extensive list of criteria to define "healthy" pregnancies excludes the majority of women but does not cancel ethnic differences in fetal growth.
通用生长图表是否可用于多民族环境，这是一个普遍关注的问题。Intergrowth-21 胎儿生长和新生儿大小标准被认为代表了无论其出生地如何的最佳胎儿生长。我们的目的是检验符合严格的 Intergrowth-21 纳入标准的女性是否更健康，胎儿生长和新生儿大小的种族差异是否更小，以及围产期不良结局是否更少。
数据来自挪威奥斯陆的一个基于人群的多民族队列，该队列包含 823 名假定健康的孕妇。我们评估了胎儿和新生儿特定胎龄 z 分数的差异，并比较了符合和不符合 Intergrowth-21 标准的妊娠的母亲健康参数、妊娠和分娩并发症。
我们队列中只有 21%的妊娠符合 Intergrowth-21 标准。胎儿生长与新标准有很大差异，特别是对欧洲裔。符合标准的妊娠中仍存在种族差异。在南亚胎儿中，24 孕周时估计胎儿体重低 0.60 SD（95%置信区间 -1.00，-0.20），出生体重低 0.62 SD（-0.95，-0.29），与欧洲裔相比。中东/北非的相应数字为 -0.13（-0.62，0.36）和 -0.60（-1.00，-0.20）。符合和不符合标准的女性的母亲健康指标和分娩并发症相似，但这种关系取决于种族。
在一个城市多民族的挪威人群中，应用广泛的标准来定义“健康”妊娠排除了大多数女性，但并没有消除胎儿生长的种族差异。
