用于识别患有 1 型糖尿病的母亲所生的大于胎龄儿和小于胎龄儿的生长标准应该是什么？CONCEPTT 试验的预先指定分析。
Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial.
机构信息
Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Box 289, Cambridge, CB2 0QQ, UK.
Cambridge Universities NHS Foundation Trust, Cambridge, UK.
出版信息
BMC Pregnancy Childbirth. 2021 Jan 29;21(1):96. doi: 10.1186/s12884-021-03554-6.
BACKGROUND
Offspring of women with type 1 diabetes are at increased risk of fetal growth patterns which are associated with perinatal morbidity. Our aim was to compare rates of large- and small-for-gestational age (LGA; SGA) defined according to different criteria, using data from the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT).
METHODS
This was a pre-specified analysis of CONCEPTT involving 225 pregnant women and liveborn infants from 31 international centres ( ClinicalTrials.gov NCT01788527; registered 11/2/2013). Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles were calculated. Relative risk ratios, sensitivity and specificity were used to assess the different growth standards with respect to perinatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome.
RESULTS
Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62, 67 and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2, 1.3 and 8.9% respectively. LGA defined according to GROW centiles showed stronger associations with preterm delivery, neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants born > 97.7th centile were at highest risk of complications. SGA defined according to INTERGROWTH centiles showed slightly stronger associations with perinatal outcomes.
CONCLUSIONS
GROW and INTERGROWTH standards performed similarly and identified similar numbers of neonates with LGA and SGA. GROW-defined LGA and INTERGROWTH-defined SGA had slightly stronger associations with neonatal complications. WHO standards underestimated size in preterm infants and are less applicable for use in type 1 diabetes.
TRIAL REGISTRATION
This trial is registered with ClinicalTrials.gov . number NCT01788527 . Trial registered 11/2/2013.
背景
患有 1 型糖尿病的女性的后代患胎儿生长模式的风险增加，这种模式与围产期发病率有关。我们的目的是使用来自连续血糖监测在 1 型糖尿病妊娠试验（CONCEPTT）的数据，比较根据不同标准定义的大、小胎龄儿（LGA；SGA）的发生率。
方法
这是 CONCEPTT 的一项预先指定的分析，涉及来自 31 个国际中心的 225 名孕妇和活产婴儿（ClinicalTrials.gov NCT01788527；注册于 2013 年 11 月 2 日）。婴儿在出生时立即称重，并计算 GROW、INTERGROWTH 和 WHO 百分位。相对风险比、灵敏度和特异性用于评估不同的生长标准与围产儿结局的关系，包括新生儿低血糖、高胆红素血症、呼吸窘迫、新生儿重症监护病房（NICU）入院和新生儿复合结局。
结果
胎儿生长加速很常见，使用 GROW、INTERGROWTH 和 WHO 标准，平均出生体重百分位数分别为 82.1、85.7 和 63.9，LGA 发生率分别为 62、67 和 30%。相应的 SGA 发生率分别为 2.2%、1.3%和 8.9%。根据 GROW 百分位定义的 LGA 与早产、新生儿低血糖、高胆红素血症和 NICU 入院的关系更强。出生时大于 97.7 百分位的婴儿发生并发症的风险最高。根据 INTERGROWTH 百分位定义的 SGA 与围产儿结局的关系稍强。
结论
GROW 和 INTERGROWTH 标准的表现相似，并且确定了具有相似数量的 LGA 和 SGA 的新生儿。GROW 定义的 LGA 和 INTERGROWTH 定义的 SGA 与新生儿并发症的关系稍强。根据 WHO 标准，早产儿的体型被低估，在 1 型糖尿病中不太适用。
试验注册
本试验在 ClinicalTrials.gov 注册，编号为 NCT01788527，于 2013 年 11 月 2 日注册。
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