调整胎儿性别的生长标准可提高与死产和不良围产结局相关的小婴儿的相关性：一项全州范围的人群研究。
Adjusting growth standards for fetal sex improves correlation of small babies with stillbirth and adverse perinatal outcomes: A state-wide population study.
机构信息
Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
出版信息
PLoS One. 2022 Oct 10;17(10):e0274521. doi: 10.1371/journal.pone.0274521. eCollection 2022.
OBJECTIVES
Sex impacts birthweight, with male babies heavier on average. Birthweight charts are thus sex specific, but ultrasound fetal weights are often reported by sex neutral standards. We aimed to identify what proportion of infants would be re-classified as SGA if sex-specific charts were used, and if this had a measurable impact on perinatal outcomes.
METHODS
Retrospective cohort study including all infants born in Victoria, Australia, from 2005-2015 (529,261 cases). We applied GROW centiles, either adjusted or not adjusted for fetal sex. We compared overall SGA populations, and the populations of males considered small by sex-specific charts only (SGAsex-only), and females considered small by sex-neutral charts only (SGAunadjust-only).
RESULTS
Of those <10th centile by sex-neutral charts, 39.6% were male and 60.5% female, but using sex-specific charts, 50.3% were male and 49.7% female. 19.2% of SGA females were reclassified as average for gestational age (AGA) using sex-specific charts. These female newborns were not at increased risk of stillbirth, combined perinatal mortality, NICU admissions, low Apgars or emergency CS compared with an AGA infant, but were at greater risk of being iatrogenically delivered on suspicion of growth restriction. 25.0% male infants were reclassified as SGA by sex-specific charts. These male newborns, compared to the AGAall infant, were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90), combined perinatal mortality (RR 1.80, 95%CI 1.26-2.57), NICU admissions (RR 1.38, 95%CI 1.12-1.71), Apgars <7 at 5 minutes (RR 1.40, 95%CI 1.25-1.56) and emergency CS (RR 1.12, 95%CI 1.06-1.18).
CONCLUSIONS
Use of growth centiles not adjusted for fetal sex disproportionately classifies female infants as SGA, increasing their risk of unnecessary intervention, and fails to identify a cohort of male infants at increased risk of adverse outcomes, including stillbirth. Sex-specific charts may help inform decisions and improve outcomes.
目的
性别会影响出生体重，一般来说男婴更重。因此，出生体重图表是有性别特异性的，但超声胎儿体重通常以中性性别标准报告。我们旨在确定如果使用性别特异性图表，有多少婴儿会被重新归类为 SGA，如果这对围产期结局有可衡量的影响。
方法
回顾性队列研究包括 2005 年至 2015 年在澳大利亚维多利亚州出生的所有婴儿（529261 例）。我们应用了 GROW 百分位数，无论是否根据胎儿性别进行了调整。我们比较了整体 SGA 人群，以及仅通过性别特异性图表被认为较小的男性人群（SGAsex-only）和仅通过中性性别图表被认为较小的女性人群（SGAunadjust-only）。
结果
在中性性别图表中处于<10 百分位的婴儿中，39.6%为男性，60.5%为女性，但使用性别特异性图表时，50.3%为男性，49.7%为女性。19.2%的 SGA 女性在使用性别特异性图表时被重新归类为胎龄平均（AGA）。与 AGA 婴儿相比，这些女婴在出生时并未增加死胎、围产儿死亡率、新生儿重症监护病房（NICU）入院、低 Apgar 评分或急诊剖宫产的风险，但因怀疑生长受限而被人为分娩的风险更高。25.0%的男性婴儿在性别特异性图表中被重新归类为 SGA。与 AGAall 婴儿相比，这些男婴死胎的风险更高（RR 1.94，95%CI 1.30-2.90），围产儿死亡率（RR 1.80，95%CI 1.26-2.57）、NICU 入院率（RR 1.38，95%CI 1.12-1.71）、5 分钟时 Apgar 评分<7（RR 1.40，95%CI 1.25-1.56）和急诊剖宫产（RR 1.12，95%CI 1.06-1.18）的风险更高。
结论
不根据胎儿性别调整生长百分位数会不成比例地将女性婴儿归类为 SGA，增加她们不必要干预的风险，并且无法识别出一组男婴有更高的不良结局风险，包括死胎。性别特异性图表可能有助于做出决策并改善结局。
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