Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
J Glob Health. 2023 Sep 11;13:04070. doi: 10.7189/jogh.13.04070.
We aimed to estimate latent foetal growth conditions and explore their determinants among maternal characteristics and ultrasound biometric parameters. We additionally investigated the influence of foetal growth conditions on perinatal variables.
We used data from live-born singletons in the Maternal and Child Health and Nutrition in Acre, Brazil (MINA-Brazil Study) population-based birth cohort. Maternal and perinatal characteristics were assessed in medical records from the maternity hospital and interviews with participants from July 2015 to June 2016. A sub-sample went through ultrasound examinations during the antenatal period, with assessment of foetal head and abdominal circumferences, and femur length. We estimated latent foetal growth conditions with a structural equation modelling framework, informed by the child's birth weight z-scores (BWZ) and birth length z-scores (BLZ) according to gestational age. Odds ratios and 95% confidence intervals (CIs) for the occurrence of perinatal events were estimated according to linear predictions of the latent variable.
We included 1253 participants. Latent foetal growth conditions explained 88.3% of BWZ and 53.7% of BLZ variation. Maternal elevated blood pressure, primiparity, smoking, malaria, and insufficient gestational weight gain negatively impacted foetal growth conditions. In the subsample (n = 499), ultrasound biometric parameters assessed at 28 weeks were positively associated with the latent variable, with the largest contribution from foetal abdominal circumference. Each standardised unit of predicted foetal growth conditions halved the chance for preterm birth (95% CI = 0.26, 0.74) and longer hospital stay (>3 days) (95% CI = 0.28, 0.88). Conversely, BWZ and BLZ were not independently associated with these perinatal variables in separate logistic regression models.
Latent foetal growth conditions jointly encompassing weight gain and linear growth during gestation were negatively influenced by a scenario of dual burden of maternal morbidities, with perinatal implications.
本研究旨在通过评估母体特征和超声生物参数，来估计潜在的胎儿生长条件，并探讨其决定因素。我们还研究了胎儿生长条件对围产变量的影响。
我们使用了巴西阿克里母婴健康和营养研究（MINA-Brazil 研究）基于人群的出生队列中活产单胎的数据。通过产妇医院的病历和 2015 年 7 月至 2016 年 6 月间对参与者的访谈，评估了产妇和围产期特征。在产前期间，对一个亚样本进行了超声检查，评估胎儿头围和腹围以及股骨长。我们根据胎儿出生体重 z 分数（BWZ）和根据胎龄的出生长度 z 分数（BLZ），通过结构方程模型框架来估计潜在的胎儿生长条件。根据潜在变量的线性预测，我们估计了围产事件发生的比值比和 95%置信区间（CI）。
我们共纳入了 1253 名参与者。潜在的胎儿生长条件解释了 BWZ 变化的 88.3%和 BLZ 变化的 53.7%。母亲血压升高、初产、吸烟、疟疾和妊娠期体重增加不足会对胎儿生长条件产生负面影响。在亚样本（n=499）中，在 28 周时评估的超声生物参数与潜在变量呈正相关，其中胎儿腹围的贡献最大。预测胎儿生长条件的每个标准化单位减少了早产的机会（95%CI=0.26，0.74）和更长的住院时间（>3 天）（95%CI=0.28，0.88）。相反，在单独的逻辑回归模型中，BWZ 和 BLZ 与这些围产变量没有独立关联。
潜在的胎儿生长条件共同包含了妊娠期体重增加和线性生长，受到母体合并症双重负担的负面影响，对围产结局有影响。
