评估用于检测小于胎龄儿和大于胎龄儿不良结局的估计胎儿体重图表性能的比较：一项基于法国人群的研究。

Comparison of the performance of estimated fetal weight charts for the detection of small- and large-for-gestational age newborns with adverse outcomes: a French population-based study.

作者信息

Monier I, Ego A, Benachi A, Hocquette A, Blondel B, Goffinet F, Zeitlin J

机构信息

Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Epidemiology and Statistics Research Centre (CRESS), Institut national de la santé et de la recherche médicale (INSERM), Institut national de la recherche agronomique (INRA), Université de Paris, Paris, France.

Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, AP-HP, Paris Saclay University, Clamart, France.

出版信息

BJOG. 2022 May;129(6):938-948. doi: 10.1111/1471-0528.17021. Epub 2021 Nov 30.

DOI:10.1111/1471-0528.17021

PMID:34797926

Abstract

OBJECTIVE

To compare the performance of estimated fetal weight (EFW) charts at the third trimester ultrasound for detecting small- and large-for-gestational age (SGA/LGA) newborns with adverse outcomes.

DESIGN

Nationally representative observational study.

SETTING

French maternity units in 2016.

POPULATION

9940 singleton live births with an ultrasound between 30 and 35 weeks of gestation.

METHODS

We compared three prescriptive charts (INTERGROWTH-21st, World Health Organization (WHO), Eunice Kennedy Shriver National Institute of Child Health and Human Development [NICHD]), four descriptive charts (Hadlock, Fetal Medicine Foundation, two French charts) and a French customised growth model (Epopé).

MAIN OUTCOME MEASURES

SGA and LGA (birthweights <10th and >90th percentiles) associated with adverse outcomes (low Apgar score, delivery-room resuscitation, neonatal unit admission).

RESULTS

2.1% and 1.1% of infants had SGA and LGA and adverse outcomes, respectively. The sensitivity and specificity for detecting these infants with an EFW <10th and >90th percentile varied from 29-65% and 84-96% for descriptive charts versus 27-60% and 83-96% for prescriptive charts. WHO and French charts were closest to the EFW distribution, yielding a balance between sensitivity and specificity for SGA and LGA births. INTERGROWTH-21st and Epopé had low sensitivity for SGA with high sensitivity for LGA. Areas under the receiving operator characteristics curve ranged from 0.62 to 0.74, showing low to moderate predictive ability, and diagnostic odds ratios varied from 7 to 16.

CONCLUSION

Marked differences in the performance of descriptive as well as prescriptive EFW charts highlight the importance of evaluating them for their ability to detect high-risk fetuses.

TWEETABLE ABSTRACT

Choice of growth chart strongly affected identification of high-risk fetuses at the third trimester ultrasound.

摘要

目的

比较孕晚期超声检查时估计胎儿体重（EFW）图表在检测有不良结局的小于胎龄儿（SGA）和大于胎龄儿（LGA）方面的表现。

设计

具有全国代表性的观察性研究。

背景

2016年法国的产科单位。

研究对象

9940例单胎活产儿，妊娠30至35周期间接受了超声检查。

方法

我们比较了三种规定性图表（INTERGROWTH-21st、世界卫生组织（WHO）、尤妮斯·肯尼迪·施赖弗国家儿童健康与人类发展研究所 [NICHD]）、四种描述性图表（哈德洛克、胎儿医学基金会、两种法国图表）以及一种法国定制生长模型（Epopé）。

主要观察指标

与不良结局（低Apgar评分、产房复苏、新生儿病房入院）相关的SGA和LGA（出生体重<第10百分位数和>第90百分位数）。

结果

分别有2.1%和1.1%的婴儿为SGA和LGA且有不良结局。对于出生体重<第10百分位数和>第90百分位数的这些婴儿，描述性图表检测的敏感性和特异性分别为29% - 65%和84% - 96%，规定性图表检测的敏感性和特异性分别为27% - 60%和83% - 96%。WHO图表和法国图表最接近EFW分布，在SGA和LGA出生的敏感性和特异性之间取得了平衡。INTERGROWTH-21st和Epopé对SGA的敏感性较低，对LGA的敏感性较高。受试者工作特征曲线下面积范围为0.62至0.74，显示出低至中等的预测能力，诊断比值比范围为7至16。