Goto Eita
Department of Medicine and Public Health, Nagoya Medical Science Research Institute, Nagoya, Japan.
Pediatr Res. 2021 May;89(7):1742-1750. doi: 10.1038/s41390-020-01124-8. Epub 2020 Sep 12.
Early identification of pregnant women at risk of delivering small-for-gestational-age (SGA) infants is required to reduce the rates of mortality and morbidity in their whole life. This meta-analysis was performed to determine whether women with higher blood alpha-fetoprotein (AFP) levels are at increased risk of SGA.
Studies identified by searching 11 databases, including PubMed, were assessed using the Newcastle-Ottawa Scale. Subgroup and meta-regression analyses and sensitivity analysis removing a potential outlier were performed. Publication bias was assessed using Egger's test.
A total of 39 good-quality cohort studies involving 93,968 women and their newborn infants or fetuses ensured both internal and external validity. Relative risk of SGA among women with higher in comparison to lower blood AFP levels was 2.021 (95% CI: 1.751-2.334). Maternal blood AFP levels showed a dose-response relationship with risk of SGA. Relative risk was higher with diagnosis of SGA by ultrasound than actual birth weight (P = 0.004). Sources of heterogeneity, subgroups, confounding factors, or potential outliers did not alter the interpretations without publication bias (P = 0.320).
Pregnant women with higher blood AFP levels are at increased risk of SGA compared to those with lower blood AFP levels.
Pregnant women with higher blood alpha-fetoprotein levels (AFP) levels are at increased risk of small for gestational age (SGA) compared to those with lower blood AFP levels. High-quality evidence showed a dose-response relationship of maternal blood AFP levels with risk of delivering SGA and was robust to sources of heterogeneity, subgroups, confounding factors, potential outliers, or publication bias. Politically and practically, monitoring of maternal blood AFP level is strongly recommended to identify women at risk of delivering SGA.
为降低小于胎龄儿（SGA）一生的死亡率和发病率，需要尽早识别有分娩SGA婴儿风险的孕妇。本荟萃分析旨在确定血液甲胎蛋白（AFP）水平较高的女性发生SGA的风险是否增加。
通过检索包括PubMed在内的11个数据库所识别的研究，使用纽卡斯尔-渥太华量表进行评估。进行了亚组分析、meta回归分析以及去除潜在离群值的敏感性分析。使用Egger检验评估发表偏倚。
共有39项高质量队列研究，涉及93968名妇女及其新生儿或胎儿，确保了内部和外部有效性。血液AFP水平较高的女性与较低的女性相比，SGA的相对风险为2.021（95%CI：1.751 - 2.334）。孕妇血液AFP水平与SGA风险呈剂量反应关系。超声诊断SGA的相对风险高于实际出生体重（P = 0.004）。异质性来源、亚组、混杂因素或潜在离群值在无发表偏倚的情况下并未改变解释结果（P = 0.320）。
与血液AFP水平较低的孕妇相比，血液AFP水平较高的孕妇发生SGA的风险增加。
与血液AFP水平较低的孕妇相比，血液甲胎蛋白水平（AFP）较高的孕妇发生小于胎龄儿（SGA）的风险增加。高质量证据表明孕妇血液AFP水平与分娩SGA风险呈剂量反应关系，并且对异质性来源、亚组、混杂因素、潜在离群值或发表偏倚具有稳健性。在政治和实际层面，强烈建议监测孕妇血液AFP水平以识别有分娩SGA风险的女性。
