Department of Obstetrics and Gynaecology, University of Cambridge; NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
J Clin Endocrinol Metab. 2022 Mar 24;107(4):e1588-e1597. doi: 10.1210/clinem/dgab842.
Excessive birth weight is associated with maternal and neonatal complications. However, ultrasonically estimated large for gestational age (LGA; >90th percentile) predicts these complications poorly.
To determine whether a maternal serum metabolite ratio developed for fetal growth restriction (FGR) is predictive of birth weight across the whole range, including LGA at birth.
Metabolites were measured using ultrahigh performance liquid chromatography-tandem mass spectroscopy. The 4-metabolite ratio was previously derived from an analysis of FGR cases and a random subcohort from the Pregnancy Outcome Prediction study. Here, we evaluated its relationship at 36 weeks of gestational age (wkGA) with birth weight in the subcohort (n = 281). External validation in the Born in Bradford (BiB) study (n = 2366) used the metabolite ratio at 24 to 28 wkGA.
The inverse of the metabolite ratio at 36 wkGA predicted LGA at term [the area under the receiver operating characteristic curve (AUROCC) = 0.82, 95% CI 0.73 to 0.91, P = 6.7 × 10-5]. The ratio was also inversely associated with birth weight z score (linear regression, beta = -0.29 SD, P = 2.1 × 10-8). Analysis in the BiB cohort confirmed that the ratio at 24 to 28 wkGA predicted LGA (AUROCC = 0.60, 95% CI 0.54 to 0.67, P = 8.6 × 10-5) and was inversely associated with birth weight z score (beta = -0.12 SD, P = 1.3 × 10-9).
A metabolite ratio which is strongly predictive of FGR is equally predictive of LGA birth weight and is inversely associated with birth weight across the whole range.
巨大儿与母婴和新生儿并发症相关。然而，超声估计的大于胎龄儿（LGA；>第 90 百分位）对这些并发症的预测效果不佳。
确定用于胎儿生长受限（FGR）的母体血清代谢物比值是否可预测整个范围内的出生体重，包括出生时的 LGA。
使用超高效液相色谱-串联质谱法测量代谢物。四代谢物比值是从 FGR 病例和妊娠结局预测研究的随机亚组分析中得出的。在此，我们评估了其与妊娠 36 周（wkGA）亚组中出生体重的关系（n = 281）。在布拉德福德出生（BiB）研究（n = 2366）中，使用 24 至 28 wkGA 的代谢物比值进行外部验证。
36 wkGA 的代谢物比值的倒数预测足月时的 LGA [受试者工作特征曲线（AUROCC）下面积为 0.82，95%CI 为 0.73 至 0.91，P = 6.7×10-5]。该比值与出生体重 z 分数也呈负相关（线性回归，β = -0.29 SD，P = 2.1×10-8）。BiB 队列的分析证实，24 至 28 wkGA 的比值可预测 LGA（AUROCC = 0.60，95%CI 0.54 至 0.67，P = 8.6×10-5），与出生体重 z 分数呈负相关（β = -0.12 SD，P = 1.3×10-9）。
强烈预测 FGR 的代谢物比值同样可预测 LGA 出生体重，并与整个范围内的出生体重呈负相关。
