Vieira Matias C, McCowan Lesley M E, North Robyn A, Myers Jenny E, Walker James J, Baker Philip N, Dekker Gustaaf A, Kenny Louise C, Poston Lucilla, Pasupathy Dharmintra
Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College, London, UK.
School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
Acta Obstet Gynecol Scand. 2018 Aug;97(8):1015-1024. doi: 10.1111/aogs.13362. Epub 2018 May 29.
Large-for-gestational-age infants are associated with increased risk of neonatal morbidity and mortality. However, most of them will not have adverse outcomes. Our aim was to identify antenatal clinical factors associated with neonatal morbidity in large-for-gestational-age infants.
Nulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study were included. We compared maternal and fetal factors between large-for-gestational-age infants (birthweight >90th customized centile) with and without neonatal morbidity, defined as admission to a neonatal intensive care unit or severe neonatal morbidity. Factors were selected based on a priori hypotheses of association and included maternal demography, anthropometric measures and self-reported physical activity (15 and 20 weeks), fetal biometry (20 weeks), and clinical information. Multivariable logistic regression was used to identify risk factors. Stratified analyses were performed by maternal obesity and physical activity.
Among term pregnancies, prevalence of large-for-gestational-age infants was 9.3% (491/5255), with 11.8% (58/491) prevalence of neonatal morbidity. Random glucose at 20 weeks (odds ratio 1.52; 95% confidence interval 1.17-1.97, per 1 mmol/L increase) and no regular physical activity at 20 weeks (odds ratio 3.93; 95% confidence interval 1.75-8.83) were associated with increased risk of neonatal morbidity after adjustment for birthweight, gestational age at delivery and gestational diabetes. The increased risk associated with higher glucose levels was not evident in women with regular physical activity or without obesity.
Regular physical activity in mid-pregnancy is associated with lower risk for neonatal morbidity in large-for-gestational-age infants and seems to offer protection against the increased risk associated with higher maternal glucose levels.
大于胎龄儿与新生儿发病和死亡风险增加相关。然而，其中大多数不会出现不良结局。我们的目的是确定与大于胎龄儿新生儿发病相关的产前临床因素。
纳入来自妊娠结局筛查（SCOPE）研究的初产妇。我们比较了有和没有新生儿发病的大于胎龄儿（出生体重>第90定制百分位数）之间的母体和胎儿因素，新生儿发病定义为入住新生儿重症监护病房或严重新生儿发病。根据先验关联假设选择因素，包括母体人口统计学、人体测量指标和自我报告的身体活动（孕15周和20周时）、胎儿生物测量（孕20周时）以及临床信息。采用多变量逻辑回归确定危险因素。按母体肥胖和身体活动进行分层分析。
在足月妊娠中，大于胎龄儿的患病率为9.3%（491/5255），新生儿发病患病率为11.8%（58/491）。孕20周时随机血糖（比值比1.52；95%置信区间1.17 - 1.97，每增加1 mmol/L）和孕20周时无规律身体活动（比值比3.93；95%置信区间1.75 - 8.83）在调整出生体重、分娩孕周和妊娠期糖尿病后与新生儿发病风险增加相关。在有规律身体活动或无肥胖的女性中，与较高血糖水平相关的风险增加并不明显。
孕中期进行规律身体活动与大于胎龄儿新生儿发病风险较低相关，似乎能抵御与母体较高血糖水平相关的风险增加。
