Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, USA.
J Matern Fetal Neonatal Med. 2020 Jul;33(14):2415-2421. doi: 10.1080/14767058.2018.1554039. Epub 2019 Jan 3.
Infants that are small for gestational age (SGA) at birth are at increased risk for morbidity and mortality. Unfortunately, the antenatal prediction of SGA is suboptimal. We sought to: (1) examine the association between second trimester fetal abdominal circumference < 10% (2T-AClag) with SGA and other gestational and neonatal adverse outcomes; (2) assess 2T-AClag as a predictor of SGA. Retrospective study of 212 singleton gestations with 2T-AClag on routine ultrasound between 18-24 weeks. The study group was compared to 424 gestations without 2T-AClag for maternal characteristics as well as pregnancy and neonatal adverse outcomes. A multivariate logistic regression was used to determine the predictive value of 2T-AClag for SGA, adjusting for maternal and pregnancy characteristics. The screening model accuracy was assessed through receiver operating characteristic (ROC) curves. Fetal growth restriction (FGR) was defined as an estimated fetal weight (EFW) less than the 10th percentile. Gestations with 2T-AClag had higher rates of SGA (35.7 versus 11.6%, < .0001), FGR (17 versus 1.7%, < .0001), pregnancy induced hypertension (31.1 versus 17%, < .0001), preeclampsia (14.6 versus 7.8%, 0 = 0.01), abnormal umbilical artery Doppler (30 versus 5.1%, < .0001), indicated preterm birth (5.7 versus 1.9%, = .01), primary cesarean birth (29.6 versus 20.1%, = .01) and NICU admission (12.9 versus 6.4%, = .009). After adjusting for maternal and gestational risk factors, 2T-AClag remained an independent risk factor for SGA (OR 4.53, 95%CI 2.91-7.05, < .0001) and FGR (OR 11.57, 95%CI 5.02-26.65, < .0001). The inclusion of 2T-AClag in a regression model with traditional risk factors, significantly improved the model's predictability for SGA and FGR (area under ROC curve increased from 0.618 to 0.723 and 0.653 to 0.819, respectively, < .0001). Second trimester abdominal circumference (AC) lag is associated with an increased risk of SGA, FGR and other adverse outcomes. The inclusion of 2T-AClag in a screening model for prediction of SGA and FGR may improve the identification of this at-risk group and assist in customizing surveillance plans.Screening for newborns that are small for gestational age (SGA) at birth is currently suboptimal. Our study shows that second trimester abdominal circumference (AC) lag, using a parameter already routinely assessed during anatomic survey, is associated with SGA at birth and can improve current screening for growth restriction and other gestational, fetal and neonatal complications.
出生时为小于胎龄儿（SGA）的婴儿发生发病率和死亡率增加的风险增加。不幸的是，产前预测 SGA 的效果并不理想。我们旨在：（1）检查第二孕期胎儿腹围<10%（2T-AClag）与 SGA 以及其他妊娠和新生儿不良结局之间的关系；（2）评估 2T-AClag 作为 SGA 的预测指标。回顾性研究了 212 例在 18-24 周常规超声检查中存在 2T-AClag 的单胎妊娠。将研究组与 424 例无 2T-AClag 的妊娠进行比较，比较了母亲特征以及妊娠和新生儿不良结局。使用多元逻辑回归来确定 2T-AClag 对 SGA 的预测价值，并调整了母亲和妊娠特征。通过接收者操作特征（ROC）曲线评估了筛查模型的准确性。胎儿生长受限（FGR）定义为估计胎儿体重（EFW）小于第 10 百分位数。存在 2T-AClag 的妊娠具有更高的 SGA（35.7%与 11.6%， < .0001）、FGR（17%与 1.7%， < .0001）、妊娠高血压（31.1%与 17%， < .0001）、子痫前期（14.6%与 7.8%，0 = 0.01）、脐动脉多普勒异常（30%与 5.1%， < .0001）、有指征的早产（5.7%与 1.9%， = .01）、初次剖宫产（29.6%与 20.1%， = .01）和新生儿重症监护病房（NICU）入院（12.9%与 6.4%， = .009）。在调整了母亲和妊娠危险因素后，2T-AClag 仍然是 SGA（OR 4.53，95%CI 2.91-7.05， < .0001）和 FGR（OR 11.57，95%CI 5.02-26.65， < .0001）的独立危险因素。在具有传统危险因素的回归模型中纳入 2T-AClag，显著提高了 SGA 和 FGR 的模型预测能力（ROC 曲线下面积分别从 0.618 增加到 0.723 和从 0.653 增加到 0.819， < .0001）。第二孕期腹围（AC）滞后与 SGA、FGR 和其他不良结局的风险增加相关。在 SGA 和 FGR 的预测筛查模型中纳入 2T-AClag 可能会改善对该高危人群的识别，并有助于定制监测计划。目前，对出生时为小于胎龄儿（SGA）的新生儿的筛查并不理想。我们的研究表明，第二孕期腹围（AC）滞后，使用已经在解剖学检查中常规评估的参数，与出生时的 SGA 相关，并可以改善目前对生长受限和其他妊娠、胎儿和新生儿并发症的筛查。
