胎儿生长受限与孕产妇发病率之间的关联。

The Association between Fetal Growth Restriction and Maternal Morbidity.

作者信息

Hage Diab Yara, Martins Juliana G, Saade George, Kawakita Tetsuya

机构信息

Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.

出版信息

Am J Perinatol. 2024 May;41(S 01):e2195-e2201. doi: 10.1055/s-0043-1770706. Epub 2023 Jun 26.

DOI:10.1055/s-0043-1770706

PMID:37364597

Abstract

OBJECTIVE

This study aimed to compare adverse maternal outcomes between pregnancies complicated by fetal growth restriction (FGR) and those without FGR.

STUDY DESIGN

This was a secondary analysis of the data from the Consortium on Safe Labor, which was conducted from 2002 to 2008 in 12 clinical centers with 19 hospitals across 9 American College of Obstetricians and Gynecologists districts. We included singleton pregnancies without any maternal comorbidities or placenta abnormalities. We compared the outcomes of individuals with FGR with individuals without FGR. Our primary outcome was severe maternal morbidity. Our secondary outcome included various adverse maternal and neonatal outcomes. Multivariable logistic regression was performed to obtain adjusted odds ratios (aOR) and 95% confidence intervals (95% CI), adjusting for confounders. Missing values for maternal age and body mass index were imputed.

RESULTS

Of 199,611 individuals, 4,554 (2.3%) had FGR and 195,057 (97.7%) did not have FGR. Compared with the individuals without FGR, individuals with FGR had increased odds of severe maternal morbidity (0.6 vs. 1.3%; aOR: 1.97 [95% CI: 1.51-2.57]), cesarean delivery (27.7 vs. 41.2%; aOR: 2.31 [95% CI: 2.16-2.48]), pregnancy-associated hypertension (8.3 vs. 19.2%; aOR: 2.76 [95% CI: 2.55-2.99]), preeclampsia without severe features (3.2 vs. 4.7%; aOR: 1.45 [95% CI: 1.26-1.68]), preeclampsia with severe features (1.4 vs. 8.6%; aOR: 6.04 [95% CI: 5.39-6.76]), superimposed preeclampsia (18.3 vs. 30.2%; aOR: 1.99 [95% CI: 1.53-2.59]), neonatal intensive care unit admission (9.7 vs. 28.4%; aOR: 3.53 [95% CI: 3.28-3.8]), respiratory distress syndrome (2.2 vs. 7.7%; aOR: 3.57 [95% CI: 3.15-4.04]), transient tachypnea of the newborn (3.3 vs. 5.4%; aOR: 1.62 [95% CI: 1.40-1.87]), and neonatal sepsis (2.1 vs. 5.5%; aOR: 2.43 [95% CI: 2.10-2.80]).

CONCLUSION

FGR was associated with increased odds of severe maternal outcomes in addition to adverse neonatal outcomes.

KEY POINTS

· FGR is associated with cesarean section.. · FGR is not associated with severe maternal morbidity.. · FGR is related to pregnancy-associated hypertension.. · FGR is associated with neonatal morbidity..

摘要

目的

本研究旨在比较合并胎儿生长受限（FGR）的妊娠与未合并FGR的妊娠之间孕产妇不良结局的差异。

研究设计

这是一项对安全分娩联盟数据的二次分析，该联盟于2002年至2008年在美国妇产科医师学会9个地区的12个临床中心的19家医院开展。我们纳入了无任何孕产妇合并症或胎盘异常的单胎妊娠。我们比较了FGR个体与非FGR个体的结局。我们的主要结局是严重孕产妇发病。次要结局包括各种孕产妇和新生儿不良结局。进行多变量逻辑回归以获得调整后的优势比（aOR）和95%置信区间（95%CI），并对混杂因素进行调整。对孕产妇年龄和体重指数的缺失值进行了插补。

结果

在199,611例个体中，4,554例（2.3%）有FGR，195,057例（97.7%）无FGR。与非FGR个体相比，FGR个体发生严重孕产妇发病的几率增加（0.6%对1.3%；aOR：1.97[95%CI：1.51 - 2.57]）、剖宫产率增加（27.7%对41.2%；aOR：2.31[95%CI：2.16 - 2.48]）、妊娠相关高血压发生率增加（8.3%对19.2%；aOR：2.76[95%CI：2.55 - 2.99]）、非重度子痫前期发生率增加（3.2%对4.7%；aOR：1.45[95%CI：1.26 - 1.68]）、重度子痫前期发生率增加（1.4%对8.6%；aOR：6.04[95%CI：5.39 - 6.76]）、叠加子痫前期发生率增加（18.3%对30.2%；aOR：1.99[95%CI：1.53 - 2.59]）、新生儿重症监护病房入院率增加（9.7%对28.4%；aOR：3.53[95%CI：3.28 - 3.8]）、呼吸窘迫综合征发生率增加（2.2%对7.7%；aOR：3.57[95%CI：3.15 - 4.04]）、新生儿短暂性呼吸急促发生率增加（3.3%对5.4%；aOR：1.62[95%CI：1.40 - 1.87]）以及新生儿败血症发生率增加（2.1%对5.5%；aOR：2.43[95%CI：2.10 - 2.80]）。