Obstetrical Care Outcomes Assessment Program, Foundation for Health Care Quality, Seattle, WA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
Perinatal Institute, Birmingham, United Kingdom.
Am J Obstet Gynecol MFM. 2022 Mar;4(2):100545. doi: 10.1016/j.ajogmf.2021.100545. Epub 2021 Dec 4.
Fetal growth restriction is associated with stillbirth and other adverse pregnancy outcomes, and the use of the correct weight standard is an essential proxy indicator of growth status and perinatal risk.
This study aimed to assess the performance of two international birthweight standards for their ability to identify perinatal morbidity and mortality indicators associated with small for gestational age infants at term.
This retrospective cohort study used data from a multicenter perinatal quality initiative, including a multiethnic dataset of 125,826 births from 2012 to 2017. Of the singleton term births, 92,622 had complete outcome data including stillbirth, neonatal death, 5-minute Apgar score <7, neonatal glucose instability and need for newborn transfer to a higher level of care or neonatal intensive care unit admission. The customized GROW and INTERGROWTH-21 birthweight standards were applied to determine small for gestational age (<10th percentile) according to their respective methods and formulae. The associations with adverse outcomes were expressed as relative risks with 95% confidence intervals and population attributable fractions.
GROW and INTERGROWTH-21 classified 9578 (10.3%) and 4079 (4.4%) pregnancies as small for gestational age, respectively. For all of the outcomes assessed, GROW identified more small for gestational age infants with adverse outcomes than INTERGROWTH-21, including more stillbirths, perinatal deaths, low Apgar scores, glucose instability, newborn seizure, and transfers to a higher level of care. Moreover, 13 of 27 stillbirths (48%) that were small for gestational age by either method were identified as small for gestational age by GROW but not by INTERGROWTH-21. Similarly, additional cases of all other adverse outcome indicators were identified by GROW as small for gestational age, whereas INTERGROWTH-21 identified in only 1 category (glucose instability) 9 of 295 cases (3.1%), which were not identified as small for gestational age by GROW.
Customized assessment using GROW resulted in increased identification of small for gestational age term infants that were at significantly increased risk of an array of adverse pregnancy outcomes.
胎儿生长受限与死产和其他不良妊娠结局有关，而正确使用体重标准是生长状况和围产期风险的重要替代指标。
本研究旨在评估两种国际出生体重标准在识别足月小于胎龄儿相关围产发病率和死亡率指标方面的性能。
这是一项回顾性队列研究，使用了多中心围产期质量计划的数据，包括 2012 年至 2017 年来自多个种族的 125826 例单胎足月出生的数据集。在这些单胎足月出生中，有 92622 例有完整的结局数据，包括死产、新生儿死亡、5 分钟 Apgar 评分<7、新生儿血糖不稳定以及需要将新生儿转至更高水平的护理或新生儿重症监护病房。根据各自的方法和公式，应用定制的 GROW 和 INTERGROWTH-21 出生体重标准来确定小于胎龄儿（<第 10 百分位数）。不良结局的相关性用 95%置信区间和人群归因分数表示。
GROW 和 INTERGROWTH-21 将 9578（10.3%）和 4079（4.4%）例妊娠分别归类为小于胎龄儿。对于评估的所有结局，GROW 比 INTERGROWTH-21 识别出更多的小于胎龄儿发生不良结局，包括更多的死产、围产儿死亡、低 Apgar 评分、血糖不稳定、新生儿抽搐和转至更高水平的护理。此外，通过两种方法中的任何一种方法确定为小于胎龄儿的 27 例死产中的 13 例（48%），通过 GROW 确定为小于胎龄儿，但通过 INTERGROWTH-21 则没有。同样，GROW 还确定了更多其他不良结局指标的病例为小于胎龄儿，而 INTERGROWTH-21 仅在 1 个类别（血糖不稳定）中确定了 295 例中的 9 例（3.1%）为小于胎龄儿，而 GROW 则没有确定为小于胎龄儿。
使用 GROW 进行定制评估会增加对多种不良妊娠结局风险显著增加的足月小于胎龄儿的识别。
