Ramos Sebastian Z, Has Phinnara, Gimovsky Alexis C, Danilack Valery A, Savitz David A, Lewkowitz Adam K
Department of Obstetrics and Gynecology, Women & Infants Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Lifespan Biostatistics, Epidemiology, and Research Design (BERD), Rhode Island Hospital, Lifespan Healthcare System, Providence, Rhode Island.
Am J Perinatol. 2024 May;41(S 01):e1470-e1477. doi: 10.1055/a-2051-3859. Epub 2023 Mar 9.
This study aimed to evaluate whether transient fetal growth restriction (FGR) that resolves prior to delivery confers a similar risk of neonatal morbidity as uncomplicated FGR that persists at term.
This is a secondary analysis of a medical record abstraction study of singleton live-born pregnancies delivered at a tertiary care center between 2002 and 2013. Patients with fetuses that had either persistent or transient FGR and delivered at 38 weeks or later were included. Patients with abnormal umbilical artery Doppler studies were excluded. Persistent FGR was defined as estimated fetal weight (EFW) <10th percentile by gestational age from diagnosis through delivery. Transient FGR was defined as EFW <10th percentile on at least one ultrasound, but not on the last ultrasound prior to delivery. The primary outcome was a composite of neonatal morbidity: neonatal intensive care unit admission, Apgar's score <7 at 5 minutes, neonatal resuscitation, arterial cord pH <7.1, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis, or death. Baseline characteristics and obstetric and neonatal outcomes were compared using Wilcoxon's rank-sum and Fisher's exact test. Log binomial regression was used to adjust for confounders.
Of 777 patients studied, 686 (88%) had persistent FGR and 91 (12%) had transient FGR. Patients with transient FGR were more likely to have a higher body mass index, gestational diabetes, diagnosed with FGR earlier in pregnancy, have spontaneous labor, and deliver at later gestational ages. There was no difference in the composite neonatal outcome (relative risk = 1.03, 95% confidence interval [CI] 0.72, 1.47) for transient versus persistent FGR after adjusting for confounders (adjusted relative risk = 0.79, 95% CI 0.54, 1.17). There were no differences in cesarean delivery or delivery complications between groups.
Neonates born at term after transient FGR do not appear to have differences in composite morbidity compared with those where uncomplicated FGR persists at term.
· No differences in neonatal outcomes in uncomplicated persistent versus transient FGR at term.. · Transient FGR pregnancies more likely to deliver at later gestational ages.. · No differences in mode of delivery or obstetric complications in persistent versus transient FGR at term..
本研究旨在评估分娩前缓解的短暂性胎儿生长受限（FGR）与足月时持续存在的单纯性FGR相比，是否具有相似的新生儿发病风险。
这是一项对2002年至2013年在三级医疗中心分娩的单胎活产妊娠病历摘要研究的二次分析。纳入胎儿有持续性或短暂性FGR且在38周或更晚分娩的患者。排除脐动脉多普勒检查异常的患者。持续性FGR定义为从诊断到分娩的估计胎儿体重（EFW）<胎龄的第10百分位数。短暂性FGR定义为至少一次超声检查时EFW<第10百分位数，但在分娩前最后一次超声检查时不是。主要结局是新生儿发病的综合指标：新生儿重症监护病房入院、5分钟时阿氏评分<7、新生儿复苏、脐动脉血pH<7.1、呼吸窘迫综合征、新生儿短暂性呼吸急促、低血糖、败血症或死亡。使用Wilcoxon秩和检验和Fisher精确检验比较基线特征以及产科和新生儿结局。采用对数二项回归调整混杂因素。
在研究的777例患者中，686例（88%）有持续性FGR，91例（12%）有短暂性FGR。短暂性FGR患者更可能有较高的体重指数、妊娠期糖尿病、在妊娠早期诊断为FGR、自然分娩以及在较大孕周分娩。在调整混杂因素后，短暂性FGR与持续性FGR的综合新生儿结局无差异（相对风险=1.03，95%置信区间[CI]0.72，1.47）（调整后相对风险=0.79，95%CI0.54，1.17）。两组之间剖宫产或分娩并发症无差异。
短暂性FGR后足月出生的新生儿与单纯性FGR足月持续存在的新生儿相比，在综合发病率方面似乎没有差异。
· 足月时单纯性持续性FGR与短暂性FGR的新生儿结局无差异。· 短暂性FGR妊娠更可能在较大孕周分娩。· 足月时持续性FGR与短暂性FGR在分娩方式或产科并发症方面无差异。
