Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, PO Box 2040, Rotterdam 3000CA, the Netherlands.
Department of Bioinformatics, Erasmus MC, University Medical Centre, Dr. Molewaterplein 50-60, Rotterdam 3015GE, the Netherlands.
Reprod Biomed Online. 2019 Apr;38(4):613-620. doi: 10.1016/j.rbmo.2018.12.016. Epub 2018 Dec 21.
Is embryonic morphological development according to the Carnegie stages associated with pregnancy outcome?
In a tertiary hospital-based cohort, 182 singleton non-malformed pregnancies were selected. Serial transvaginal three-dimensional ultrasound (3D-US) scans were carried out between 6 and 10 gestational weeks. Embryonic development was annotated according to the morphological criteria of the Carnegie classification using a virtual reality system. Second-trimester biparietal diameter, head circumference, abdominal circumference and femur length measurements were retrieved from medical records. Z-scores were calculated for mid-pregnancy estimated fetal weight (EFW) and newborn birth weight. Associations between longitudinal Carnegie stages and fetal growth parameters were investigated using linear mixed models, with subgroup analysis based on fetal gender.
A total of 576 first-trimester 3D-US scans were analysed (median of three scans per pregnancy). Embryonic development was positively associated with EFW z-score (β = 0.69; 95% CI 0.51 to 0.86; P < 0.001), biparietal diameter and femur length, but not with head circumference, abdominal circumference and birth weight z-score. After stratification for fetal gender, positive associations for both males and females were confirmed between embryonic development and EFW z-scores. Moreover, opposite gender-specific associations were detected between embryonic development and birth weight z-scores (males: β = 0.37; 95% CI 0.04 to 0.70; P < 0.05; females: β = -0.36; 95% CI -0.62 to -0.10; P < 0.01).
Human embryonic development according to the Carnegie stages is associated with fetal growth parameters with gender-specificity of birth weight. These results emphasize the importance of the first-trimester of pregnancy, raising the morphological staging of the embryo as a new methodology for early risk assessment and improvement of subsequent fetal growth parameters.
胚胎形态发育是否符合卡内基阶段与妊娠结局有关？
在一家三级医院的队列中，选择了 182 例非畸形的单胎妊娠。在 6 至 10 孕周之间进行了经阴道三维超声（3D-US）连续扫描。胚胎发育根据卡内基分类的形态标准，使用虚拟现实系统进行注释。从中期妊娠记录中检索双顶径、头围、腹围和股骨长度的测量值。计算中孕期估计胎儿体重（EFW）和新生儿出生体重的 Z 分数。使用线性混合模型调查纵向卡内基阶段与胎儿生长参数之间的关系，并根据胎儿性别进行亚组分析。
共分析了 576 例 1 期 3D-US 扫描（每例妊娠中位数为 3 次扫描）。胚胎发育与 EFW z 分数（β=0.69；95%CI 0.51 至 0.86；P<0.001）、双顶径和股骨长度呈正相关，但与头围、腹围和出生体重 z 分数无关。在按胎儿性别分层后，男性和女性均证实胚胎发育与 EFW z 分数之间存在正相关。此外，在胚胎发育与出生体重 z 分数之间还检测到了相反的性别特异性关联（男性：β=0.37；95%CI 0.04 至 0.70；P<0.05；女性：β=-0.36；95%CI -0.62 至 -0.10；P<0.01）。
根据卡内基阶段的人类胚胎发育与胎儿生长参数有关，具有出生体重的性别特异性。这些结果强调了妊娠早期的重要性，提出了胚胎形态分期作为早期风险评估和改善后续胎儿生长参数的新方法。
