Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia.
Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, WA, Australia.
Arch Gynecol Obstet. 2020 Jun;301(6):1383-1396. doi: 10.1007/s00404-020-05537-y. Epub 2020 Apr 21.
To investigate the proportion of severely growth-restricted singleton births < 3rd percentile (proxy for severe fetal growth restriction; FGR) undelivered at 40 weeks (FGR_40), and compare maternal characteristics and outcomes of FGR_40 births and FGR births at 37-39 weeks' (FGR_37-39) to those not born small-for-gestational-age at term (Not SGA_37+).
The annual rates of singleton FGR_40 births from 2006 to 2015 were calculated using data from linked Western Australian population health datasets. Using 2013-2015 data, maternal factors associated with FGR births were investigated using multinomial logistic regression to estimate odds ratios (OR) with 95% confidence intervals (CI) while relative risks (RR) of birth outcomes between each group were calculated using Poisson regression. Neonatal adverse outcomes were identified using a published composite indicator (diagnoses, procedures and other factors).
The rate of singleton FGR_40 births decreased by 23.0% between 2006 and 2015. Factors strongly associated with FGR_40 and FGR_37-39 births compared to Not SGA_37+ births included the mother being primiparous (ORs 3.13: 95% CI 2.59-3.79; 1.69, 95% CI 1.47, 1.94, respectively) and ante-natal smoking (ORs 2.55, 95% CI 1.97, 3.32; 4.48, 95% CI 3.74, 5.36, respectively). FGR_40 and FGR_37-39 infants were more likely to have a neonatal adverse outcome (RRs 1.70, 95% CI 1.41, 2.06 and 2.46 95% CI 2.18, 2.46, respectively) compared to Not SGA 37+ infants.
Higher levels of poor perinatal outcomes among FGR births highlight the importance of appropriate management including fetal growth monitoring. Regular population-level monitoring of FGR_40 rates may lead to reduced numbers of poor outcomes.
调查出生时胎龄<第 3 百分位数（代表严重胎儿生长受限；FGR）且未在 40 周分娩的单胎出生比例（FGR_40），并比较 FGR_40 分娩和 37-39 周分娩（FGR_37-39）与足月非小于胎龄儿（Not SGA_37+）的产妇特征和结局。
使用来自西澳大利亚州人口健康数据集的链接数据，计算 2006 年至 2015 年 FGR_40 单胎出生的年度发生率。使用 2013-2015 年的数据，采用多项逻辑回归调查与 FGR 分娩相关的产妇因素，以估计比值比（OR）及其 95%置信区间（CI），同时使用泊松回归计算每组之间的出生结局相对风险（RR）。新生儿不良结局使用已发表的复合指标（诊断、程序和其他因素）来确定。
2006 年至 2015 年间，FGR_40 单胎出生率下降了 23.0%。与 Not SGA_37+ 分娩相比，FGR_40 和 FGR_37-39 分娩的强烈相关因素包括产妇为初产妇（ORs 3.13：95%CI 2.59-3.79；1.69，95%CI 1.47-1.94）和产前吸烟（ORs 2.55，95%CI 1.97-3.32；4.48，95%CI 3.74-5.36）。与 Not SGA 37+ 婴儿相比，FGR_40 和 FGR_37-39 婴儿更有可能出现新生儿不良结局（RRs 1.70，95%CI 1.41-2.06 和 2.46 95%CI 2.18-2.46）。
FGR 分娩中较高水平的围产儿不良结局突出表明需要适当的管理，包括胎儿生长监测。定期监测 FGR_40 发生率可能会减少不良结局的发生。
