Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas (UNICAMP), 101 Alexander Fleming St, Cidade Universitaria, Campinas, SP, Brazil.
Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, 10th Floor North Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
Sci Rep. 2020 Sep 7;10(1):14725. doi: 10.1038/s41598-020-71252-y.
Risk-stratification screening for SGA has been proposed in high-income countries to prevent perinatal morbidity and mortality. There is paucity of data from middle-income settings. The aim of this study is to explore risk factors for SGA in Brazil and assess potential for risk stratification. This population-based study is a secondary analysis of Birth in Brazil study, conducted in 266 maternity units between 2011 and 2012. Univariate and multivariate logistic regressions were performed, and population attributable fraction estimated for early and all pregnancy factors. We calculated absolute risk, odds ratio, and population prevalence of single or combined factors stratified by parity. Factors associated with SGA were maternal lupus (OR 4.36, 95% CI [2.32-8.18]), hypertensive disorders in pregnancy (OR 2.72, 95% CI [2.28-3.24]), weight gain < 5 kg (OR 2.37, 95% CI [1.99-2.83]), smoking at late pregnancy (OR 2.04, 95% CI [1.60-2.59]), previous low birthweight (OR 2.22, 95% CI [1.79-2.75]), nulliparity (OR 1.81, 95% CI [1.60-2.05]), underweight (OR 1.61, 95% CI [1.36-1.92]) and socioeconomic status (SES) < 5th centile (OR 1.23, 95% CI [1.05-1.45]). Having two or more risk factors (prevalence of 4.4% and 8.0%) was associated with a 2 and fourfold increase in the risk for SGA in nulliparous and multiparous, respectively. Early and all pregnancy risk factors allow development of risk-stratification for SGA. Implementation of risk stratification coupled with specific strategies for reduction of risk and increased surveillance has the potential to contribute to the reduction of stillbirth in Brazil through increased detection of SGA, appropriate management and timely delivery.
高危人群筛查法已被提出用于预防围生期发病率和死亡率，以应对高危人群筛查法在高收入国家的应用。但是，这种方法在中等收入国家的数据相对较少。本研究的目的是探讨巴西 SGA 的危险因素，并评估风险分层的可能性。这项基于人群的研究是对巴西出生研究的二次分析，该研究于 2011 年至 2012 年在 266 家产科单位进行。进行了单变量和多变量逻辑回归，并对早期和所有妊娠因素的人群归因分数进行了估计。我们根据产次对单一或联合因素进行分层，计算了绝对风险、优势比和人群流行率。与 SGA 相关的因素包括母体狼疮（OR 4.36，95%CI [2.32-8.18]）、妊娠高血压疾病（OR 2.72，95%CI [2.28-3.24]）、体重增加 < 5kg（OR 2.37，95%CI [1.99-2.83]）、妊娠晚期吸烟（OR 2.04，95%CI [1.60-2.59]）、既往低出生体重（OR 2.22，95%CI [1.79-2.75]）、初产（OR 1.81，95%CI [1.60-2.05]）、体重不足（OR 1.61，95%CI [1.36-1.92]）和社会经济地位（SES）<5 百分位数（OR 1.23，95%CI [1.05-1.45]）。在初产妇和经产妇中，具有两个或更多危险因素（流行率分别为 4.4%和 8.0%），其 SGA 的风险分别增加了 2 倍和 4 倍。早期和所有妊娠危险因素均有助于 SGA 风险分层的发展。实施风险分层，并结合特定的降低风险和加强监测策略，有可能通过增加对 SGA 的检测、适当的管理和及时分娩，为降低巴西的死产率做出贡献。
