Costantine Maged M, Tita Alan T N, Mele Lisa, Casey Brian M, Peaceman Alan M, Varner Michael W, Reddy Uma M, Wapner Ronald J, Thorp John M, Saade George R, Rouse Dwight J, Sibai Baha, Mercer Brian M, Caritis Steve N
Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
University of Alabama at Birmingham, Birmingham, Alabama.
Am J Perinatol. 2024 May;41(S 01):e1313-e1323. doi: 10.1055/s-0043-1761920. Epub 2023 Feb 15.
The aim of this study was to evaluate whether being small for gestational age (SGA) or large for gestational age (LGA) or having a small or large head circumference (HC) at birth is associated with adverse neurodevelopmental outcomes.
This is a secondary analysis of a multicenter negative randomized trial of thyroxine therapy for subclinical hypothyroid disorders in pregnancy. The primary outcome was child intelligence quotient (IQ) at 5 years of age. Secondary outcomes included several neurodevelopmental measures. Associations between the outcomes in children with SGA (<10th percentile) or LGA (>90th percentile) birth weights, using ethnicity- and sex-specific population nomogram as well as nomograms from the National Fetal Growth (NFG) study, were compared with the referent of those with appropriate for gestational age (AGA) birth weight. Similar analyses were performed for HC.
Using the population nomogram, 90 (8.2%) were SGA and 112 (10.2%) were LGA. SGA neonates were more likely to be born preterm to mothers who were younger, smoked, and were less likely to have less than a high school education, whereas LGA neonates were more likely to be born to mothers who were older and have higher body mass index, compared with AGA neonates. SGA at birth was associated with a decrease in the child IQ at 5 years of age by 3.34 (95% confidence interval [CI], 0.54-6.14) points, and an increase in odds of child with an IQ < 85 (adjusted odds ratio [aOR], 1.9; 95% CI, 1.1-3.2). There was no association between SGA and other secondary outcomes, or between LGA and the primary or secondary outcomes. Using the NFG standards, SGA at birth remained associated with a decrease in the child IQ at 5 years of age by 3.14 (95% CI, 0.22-6.05) points and higher odds of an IQ < 85 (aOR, 2.3; 95% CI, 1.3-4.1), but none of the other secondary outcomes. HC was not associated with the primary outcome, and there were no consistent associations of these standards with the secondary outcomes.
In this cohort of pregnant individuals with hypothyroid disorders, SGA birth weight was associated with a decrease in child IQ and greater odds of child IQ < 85 at 5 years of age. Using a fetal growth standard did not appear to improve the detection of newborns at risk of adverse neurodevelopment.
本研究旨在评估小于胎龄儿（SGA）或大于胎龄儿（LGA），或出生时头围小或大是否与不良神经发育结局相关。
这是一项对妊娠亚临床甲状腺功能减退症甲状腺素治疗的多中心阴性随机试验的二次分析。主要结局是5岁儿童的智商（IQ）。次要结局包括多项神经发育指标。使用种族和性别特异性人群列线图以及国家胎儿生长（NFG）研究的列线图，比较SGA（<第10百分位数）或LGA（>第90百分位数）出生体重儿童的结局与适于胎龄儿（AGA）出生体重儿童的结局。对头围进行了类似分析。
使用人群列线图，90例（8.2%）为SGA，112例（10.2%）为LGA。与AGA新生儿相比，SGA新生儿更可能早产，其母亲更年轻、吸烟，且受教育程度低于高中的可能性更小，而LGA新生儿更可能出生于年龄较大且体重指数较高的母亲。出生时SGA与5岁儿童智商降低3.34（95%置信区间[CI]，0.54 - 6.14）分相关，且智商<85的儿童几率增加（调整优势比[aOR]，1.9；95%CI，1.1 - 3.2）。SGA与其他次要结局之间、LGA与主要或次要结局之间均无关联。使用NFG标准，出生时SGA仍与5岁儿童智商降低3.14（95%CI，0.22 - 6.05）分及智商<85的几率更高（aOR，2.3；95%CI，1.3 - 4.1）相关，但与其他次要结局均无关联。头围与主要结局无关，这些标准与次要结局也无一致关联。
在这个患有甲状腺功能减退症的孕妇队列中，SGA出生体重与5岁儿童智商降低以及智商<85的几率增加相关。使用胎儿生长标准似乎并未改善对有不良神经发育风险新生儿的检测。
