Department of Obstetrics and Gynaecology, University Hospital of Puerto Real, Puerto Real, Cadiz, Spain.
Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA). Fundación Cádiz - Hospital Universitario Puerto del Mar, 9º planta. Avda. Ana de Viya, 21 - 11009, Cadiz, Spain.
BMC Pregnancy Childbirth. 2022 Feb 19;22(1):136. doi: 10.1186/s12884-022-04450-3.
Hypertensive disorders of pregnancy (HDP) generate complications and are one of the principal causes of maternal, foetal, and neonatal mortality worldwide. It has been observed that in pregnancies with HDP, the incidence of foetuses small for their gestational age (SGA) is twice as high as that in noncomplicated pregnancies. In women with HDP, the identification of foetuses (SGA) is substantially important, as management and follow-up are determined by this information.
The objective of this study was to evaluate whether the INTERGROWTH-21st method or customized birthweight references better identify newborns with an abnormal nutritional status resulting from HDP.
A comparative analysis study was designed with two diagnostic methods for the prediction of neonatal nutritional status in pregnancies with HDP. The performance of both methods in identifying neonatal malnutrition (defined by a neonatal body mass index < 10 centile or a ponderal index < 10 centile) was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratio, Youden's index and probability ratios.
The study included 226 pregnant women diagnosed with HDP. The customized method identified 45 foetuses as small for gestational age (19.9%), while the INTERGROWTH-21st method identified 27 newborns with SGA (11.9%). The difference between proportions was statistically significant (p < 0.01). Using body mass index (< 10 centile) as a measure of nutritional status, newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH-21st (RR: 4.87 (95% CI: 1.86-12.77) vs. 3.75 (95% CI: 1.49-9.43)) (DOR: 5.56 (95% CI: 1.82-16.98) vs. 4.84 (95% CI: 1.51-15.54)) Even when using Ponderal index (< 10 centile), newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH-21st (RR 2.37 (95% CI: 1.11-5.05) vs. 1.68 (95% CI: 0.70-4.03))(DOR 2.62 (95% CI: 1.00-6.87) vs. 1.90 (95% CI: 0.61-5.92)).
In pregnant women with HDP, the predictive ability of the customized foetal growth curves to identify neonatal malnutrition appears to surpass that of INTERGROWTH-21st.
妊娠高血压疾病（HDP）会引发多种并发症，是导致全球孕产妇、胎儿和新生儿死亡的主要原因之一。研究发现，患有 HDP 的孕妇所分娩的胎儿中，生长受限（SGA）的发生率是无并发症孕妇的两倍。在 HDP 孕妇中，识别胎儿（SGA）具有重要意义，因为管理和随访取决于这一信息。
本研究旨在评估 INTERGROWTH-21st 方法或定制的出生体重参考值是否能更好地识别因 HDP 而导致的新生儿营养状况异常。
设计了一项比较分析研究，采用两种诊断方法预测 HDP 孕妇的新生儿营养状况。通过计算灵敏度、特异性、阳性预测值、阴性预测值、诊断比值比、Youden 指数和概率比，评估两种方法在识别新生儿营养不良（定义为新生儿体重指数 < 第 10 百分位数或体质量指数 < 第 10 百分位数）方面的表现。
本研究纳入了 226 例 HDP 孕妇。定制方法识别出 45 名胎儿为生长受限（19.9%），而 INTERGROWTH-21st 方法识别出 27 名 SGA 新生儿（11.9%）。比例之间的差异具有统计学意义（p < 0.01）。使用体重指数（< 第 10 百分位数）作为营养状况的衡量标准，与 INTERGROWTH-21st 方法识别的 SGA 新生儿相比，定制方法识别的 SGA 新生儿营养不良的风险更高（RR：4.87（95%CI：1.86-12.77）vs. 3.75（95%CI：1.49-9.43））（DOR：5.56（95%CI：1.82-16.98）vs. 4.84（95%CI：1.51-15.54））。即使使用体质量指数（< 第 10 百分位数），与 INTERGROWTH-21st 方法识别的 SGA 新生儿相比，定制方法识别的 SGA 新生儿营养不良的风险更高（RR 2.37（95%CI：1.11-5.05）vs. 1.68（95%CI：0.70-4.03））（DOR 2.62（95%CI：1.00-6.87）vs. 1.90（95%CI：0.61-5.92））。
在 HDP 孕妇中，定制胎儿生长曲线预测新生儿营养不良的能力似乎优于 INTERGROWTH-21st。
