Department of Obstetrics and Gynaecology, Shaare Zedek Medical Centre, Jerusalem, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel.
Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Soroka University Medical Centre, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Arch Gynecol Obstet. 2020 Nov;302(5):1159-1166. doi: 10.1007/s00404-020-05725-w. Epub 2020 Aug 3.
Over the past years, the prevalence of various risk factors for small for gestational age (SGA) neonates has changed. Little is known if there was also a change in the specific contribution of these risk factors to the prevalence of SGA. We aim to identify trends in the specific contribution of various risk factors for SGA by observing their odds ratios (ORs) throughout different time periods.
A nested case-control study was conducted. The ORs for selected known risk factors for SGA occurring in three consecutive 8-year intervals between 1988 and 2014 (T1 - 1988-1996; T2 - 1997-2005; T3 - 2006-2014) were compared. Data were retrieved from the medical centre's computerized perinatal database. Multivariable logistic regression models were constructed and ORs were compared to identify the specific contribution of independent risk factors for SGA along the study period.
During the study period, 285,992 pregnancies met the study's inclusion criteria, of which 15,013 (5.25%) were SGA. Between 1988 and 2014, the incidence of SGA increased from 2.6% in 1988 to 2.9% in 2014. Using logistic regression models, nulliparity, maternal age, gestational age, hypertensive disorders of pregnancy, oligohydramnios and pre-gestational diabetes mellitus were found to be independently associated with SGA. While the adjusted ORs (aOR) of hypertensive disorders of pregnancy and pre-gestational diabetes mellitus had increased, aORs for nulliparity, maternal age and gestational age had remained stable over time. Oligohydramnios had demonstrated a mixed trend of change over the time.
In our study, the specific contribution of factors associated with SGA had changed over time. Having a better understating of the changes in the specific contribution of different risk factors for SGA may enable obstetricians to provide consultations.
在过去的几年中，各种导致胎儿生长受限（SGA）的危险因素的流行情况已经发生了变化。目前尚不清楚这些危险因素对 SGA 患病率的具体影响是否也发生了变化。我们旨在通过观察不同时间段内各种危险因素对 SGA 的比值比（OR）来确定其特定贡献的变化趋势。
进行了一项嵌套病例对照研究。比较了 1988 年至 2014 年期间三个连续的 8 年时间段（T1 - 1988-1996 年；T2 - 1997-2005 年；T3 - 2006-2014 年）中发生的 SGA 相关已知危险因素的 OR。数据来自医疗中心的计算机围产数据库。构建了多变量逻辑回归模型，并比较了 OR，以确定 SGA 相关的独立危险因素在研究期间的特定贡献。
在研究期间，共有 285992 例妊娠符合研究纳入标准，其中 15013 例（5.25%）为 SGA。1988 年至 2014 年间，SGA 的发生率从 1988 年的 2.6%上升至 2014 年的 2.9%。使用逻辑回归模型，发现初产妇、母亲年龄、妊娠周数、妊娠期高血压疾病、羊水过少和孕前糖尿病与 SGA 独立相关。虽然妊娠期高血压疾病和孕前糖尿病的调整比值比（aOR）有所增加，但初产妇、母亲年龄和妊娠周数的 aOR 随着时间的推移保持稳定。羊水过少则呈现出随时间变化的混合趋势。
在我们的研究中，与 SGA 相关的因素的特定贡献随时间发生了变化。更好地了解不同危险因素对 SGA 的特定贡献的变化，可能使产科医生能够提供咨询服务。
