母亲消瘦和肥胖与定制胎儿体重图表。

Maternal Thinness and Obesity and Customized Fetal Weight Charts.

机构信息

Obstetrics and Gynecology Department, University of La Laguna, Canary Islands, University Hospital of Canary Islands., La Laguna, Spain.

Mathematics, Statistics and Operations Research Department, University of La Laguna, La Laguna, Spain.

出版信息

Fetal Diagn Ther. 2021;48(7):551-559. doi: 10.1159/000515251. Epub 2021 Aug 18.

DOI:10.1159/000515251

PMID:34407539

Abstract

OBJECTIVE

The aim of the study was to determine if customized fetal growth charts developed excluding obese and underweight mothers (CC(18.5-25)) are better than customized curves (CC) at identifying pregnancies at risk of perinatal morbidity.

MATERIAL AND METHODS

Data from 20,331 infants were used to construct CC and from 11,604 for CC(18.5-25), after excluding the cases with abnormal maternal BMI. The 2 models were applied to 27,507 newborns and the perinatal outcomes were compared between large for gestational age (LGA) or small for gestational age (SGA) according to each model. Logistic regression was used to calculate the OR of outcomes by the group, with gestational age (GA) as covariable. The confidence intervals of pH were calculated by analysis of covariance.

RESULTS

The rate of cesarean and cephalopelvic disproportion (CPD) were higher in LGAonly by CC(18.5-25) than in LGAonly by CC. In SGAonly by CC(18.5-25), neonatal intensive care unit (NICU) and perinatal mortality rates were higher than in SGAonly by CC. Adverse outcomes rate was higher in LGAonly by CC(18.5-25) than in LGAonly by CC (21.6%; OR = 1.61, [1.34-193]) vs. (13.5%; OR = 0.84, [0.66-1.07]), and in SGA only by CC(18.5-25) than in SGAonly by CC (9.6%; OR = 1.62, [1.25-2.10] vs. 6.3%; OR = 1.18, [0.85-1.66]).

CONCLUSION

The use of CC(18.5-25) allows a more accurate identification of LGA and SGA infants at risk of perinatal morbidity than conventional CC. This benefit increase and decrease, respectively, with GA.

摘要

目的

本研究旨在确定排除肥胖和体重不足母亲后制定的定制胎儿生长图表（CC（18.5-25））是否优于定制曲线（CC），以识别有围产期发病风险的妊娠。

材料和方法

使用 20331 名婴儿的数据构建 CC，并使用 11604 名婴儿的数据构建 CC（18.5-25），排除异常母体 BMI 的病例。将这两种模型应用于 27507 名新生儿，并根据每种模型比较巨大儿（LGA）或小于胎龄儿（SGA）的围产结局。使用逻辑回归计算组别的 OR，并将胎龄（GA）作为协变量。通过协方差分析计算 pH 的置信区间。

结果

仅根据 CC（18.5-25），LGA 的剖宫产率和头盆不称（CPD）率高于仅根据 CC 的 LGA。仅根据 CC（18.5-25），SGA 的新生儿重症监护病房（NICU）和围产儿死亡率高于仅根据 CC 的 SGA。LGA 仅根据 CC（18.5-25）的不良结局率高于 LGA 仅根据 CC（21.6%；OR=1.61，[1.34-193]），而 SGA 仅根据 CC（18.5-25）的不良结局率高于 SGA 仅根据 CC（9.6%；OR=1.62，[1.25-2.10]）。