International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
International Peace Maternity and Child Health Hospital, China Welfare Institution, Shanghai, China.
BMC Pediatr. 2022 Jul 1;22(1):386. doi: 10.1186/s12887-022-03426-8.
To investigate the association of crown-rump length (CRL) during the first trimester of pregnancy with neonatal outcomes.
A total of 15,524 women with a reliable first day of the last menstrual period and a regular menstrual cycle (28 ± 4 days) were included from January 2015 to November 2016. CRL was measured by ultrasound from 7 to 13 weeks during pregnancy and transformed to a standard deviation score (SDS) adjusted for gestational age. Linear regression was used to explore risk factors for CRL. A generalised linear model was used to evaluate the association between CRL and neonatal outcomes.
In the multivariate analysis, maternal age (0.25 mm, 95% CI = [0.22-0.28], P < 0.001; 0.04 SDS, 95% CI = [0.03-0.04], P < 0.001), multipara (0.30 mm, 95% CI = [0.08-0.52], P = 0.007; 0.04 SDS, 95% CI = [0.00-0.07], P = 0.031) and folic acid supplement use (0.78 mm, 95% CI = [0.49-1.08], P < 0.001; 0.05 SDS, 95% CI = [0.01-0.10], P < 0.019) were positively associated with CRL, while pre-pregnancy BMI (-0.17 mm, 95% CI = [-0.21 to -0.13], P < 0.001; -0.02 SDS, 95% CI = [-0.03 to -0.02], P < 0.001) was negatively related to CRL. For neonatal outcomes, CRL was negatively associated with small for gestational age (SGA) ([risk ratio] (RR) = 0.733, 95% [CI] = 0.673-0.8004, P < 0.001) and neonatal intensive care unit (NICU) admission ([RR] = 0.928, 95% [CI] = 0.883-0.976, P = 0.003), and preterm birth ([RR] = 1.082, 95% [CI] = 1.008-1.162, P = 0.029), but positively related to large for gestational age (LGA) ([RR] = 1.241, 95% [CI] = 1.184-1.301, P = 0.012). When stratified by pre-pregnancy BMI, the risk of SGA and LGA remained significant in all groups, while the increased risk of preterm birth was only observed in the lean group (BMI < 18.5 kg/m) and decreased risk of NICU admission rate in the normal group (BMI 18.5-24 kg/m).
Maternal characteristics were independently associated with CRL in the first trimester, which was negatively related to foetal size, SGA, preterm birth, and admission rate to the NICU, but positively related to LGA.
研究妊娠早期的头臀长（CRL）与新生儿结局的关系。
共纳入 2015 年 1 月至 2016 年 11 月期间 15524 名月经周期规律（28±4 天）、末次月经日期可靠的孕妇。妊娠 7-13 周时通过超声测量 CRL，并转化为按胎龄调整的标准差评分（SDS）。采用线性回归分析 CRL 的危险因素。采用广义线性模型评估 CRL 与新生儿结局的关系。
多变量分析中，母亲年龄（0.25mm，95%CI=0.22-0.28，P<0.001；0.04 SDS，95%CI=0.03-0.04，P<0.001）、多胎（0.30mm，95%CI=0.08-0.52，P=0.007；0.04 SDS，95%CI=0.00-0.07，P=0.031）和叶酸补充剂的使用（0.78mm，95%CI=0.49-1.08，P<0.001；0.05 SDS，95%CI=0.01-0.10，P<0.019）与 CRL 呈正相关，而孕前 BMI（-0.17mm，95%CI=0.21-0.13，P<0.001；-0.02 SDS，95%CI=0.03-0.02，P<0.001）与 CRL 呈负相关。对于新生儿结局，CRL 与小于胎龄儿（SGA）（[风险比]（RR）=0.733，95%[置信区间]（CI）=0.673-0.8004，P<0.001）和新生儿重症监护病房（NICU）入院（[RR] =0.928，95%[CI] =0.883-0.976，P=0.003）呈负相关，与早产（[RR] =1.082，95%[CI] =1.008-1.162，P=0.029）呈正相关，但与大于胎龄儿（LGA）（[RR] =1.241，95%[CI] =1.184-1.301，P=0.012）呈正相关。按孕前 BMI 分层后，SGA 和 LGA 的风险在所有组中均保持显著，而早产的风险仅在消瘦组（BMI<18.5kg/m）中增加，NICU 入院率在正常组（BMI 18.5-24kg/m）中降低。
孕妇特征与妊娠早期的 CRL 独立相关，CRL 与胎儿大小、SGA、早产和 NICU 入院率呈负相关，而与 LGA 呈正相关。
