Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu, China.
Int J Gynaecol Obstet. 2024 Apr;165(1):220-228. doi: 10.1002/ijgo.15098. Epub 2023 Sep 19.
To investigate the effect of low-molecular-weight heparin (LMWH) on placenta-mediated fetal growth restriction (FGR).
A cohort of 570 pregnant women diagnosed with placenta-mediated FGR were enrolled from January 1, 2015 through to December 31, 2021. A birth database, including demographic data, antenatal complications, and detailed delivery and newborn data, was created to collect variables from the Hospital Information System (HIS) Database. The unique personal registration number, assigned to each patient on first registration with HIS in the West China Second University Hospital, was used to link these patients. LMWH use was defined as at least 1-week prescription from diagnosis of placenta-mediated FGR. Pregnant women received LMWH (Enoxaparin 4000 IU/day) by self-administered subcutaneous injection only when they agreed and signed informed consent. Primary outcome was intrauterine fetal death after 20 weeks of pregnancy. Secondary outcomes included preterm birth (PB), Apgar score less than 7 at 1 min, admission to neonatal intensive care unit (NICU), and birth weight. Logistic regression analysis was conducted to compute adjusted odds ratio (aOR) with 95% confidence intervals (CI) for outcomes.
After controlling for confounders, LMWH use was associated with a decreased risk of intrauterine fetal death (aOR 2.49, 95% CI 1.35-4.57, P = 0.003), PB before 37 weeks of pregnancy (aOR 3.35, 95% CI 2.14-5.23, P < 0.001), PB before 34 weeks of pregnancy (aOR 2.25, 95% CI 1.36-3.74, P = 0.002), Apgar score less than 7 at 1 min (aOR 2.25, 95% CI 1.36-3.74, P = 0.002), NICU admission (aOR 2.29, 95% CI 1.48-3.55, P < 0.001). Using LMWH increased the mean birth weight in PB before 32 weeks of pregnancy (mean ± standard deviation [SD] 1126.4 ± 520.0 g, P = 0.020), PB before 37 weeks of pregnancy (mean ± SD 1563.9 ± 502.7 g, P = 0.019), early-onset FGR (mean ± SD 2125.2 ± 665.7 g, P < 0.001), late-onset FGR (mean ± SD 2343.4 ± 507.9, P < 0.001), and non-severe FGR (mean ± SD 2231.1 ± 607.2 g, P < 0.001).
Use of LMWH can significantly improve the fetal and neonatal outcomes among pregnant women with placenta-mediated FGR, particularly reducing the risk of intrauterine fetal death.
探讨低分子肝素（LMWH）对胎盘介导胎儿生长受限（FGR）的影响。
本研究纳入了 2015 年 1 月 1 日至 2021 年 12 月 31 日期间被诊断为胎盘介导 FGR 的 570 名孕妇。我们创建了一个出生数据库，包括人口统计学数据、产前并发症以及详细的分娩和新生儿数据，这些数据均从医院信息系统（HIS）数据库中收集。每位患者在华西第二医院首次登记 HIS 时，都会获得一个唯一的个人注册号码，用于将这些患者进行关联。LMWH 的使用定义为在诊断为胎盘介导 FGR 后至少开具 1 周的处方。当患者同意并签署知情同意书时，仅通过自行皮下注射给予 LMWH（依诺肝素 4000 IU/天）。主要结局为妊娠 20 周后宫内胎儿死亡。次要结局包括早产（PB）、1 分钟时 Apgar 评分<7、新生儿重症监护病房（NICU）收治和出生体重。采用 logistic 回归分析计算调整后的比值比（aOR）及其 95%置信区间（CI），以评估结局。
在校正混杂因素后，LMWH 的使用与宫内胎儿死亡风险降低相关（aOR 2.49，95%CI 1.35-4.57，P=0.003）、妊娠 37 周前 PB（aOR 3.35，95%CI 2.14-5.23，P<0.001）、妊娠 34 周前 PB（aOR 2.25，95%CI 1.36-3.74，P=0.002）、1 分钟时 Apgar 评分<7（aOR 2.25，95%CI 1.36-3.74，P=0.002）、NICU 收治（aOR 2.29，95%CI 1.48-3.55，P<0.001）的风险降低相关。使用 LMWH 可增加妊娠 32 周前 PB（平均±标准差[SD] 1126.4±520.0 g，P=0.020）、妊娠 37 周前 PB（平均±SD 1563.9±502.7 g，P=0.019）、早发型 FGR（平均±SD 2125.2±665.7 g，P<0.001）、晚发型 FGR（平均±SD 2343.4±507.9 g，P<0.001）和非严重型 FGR（平均±SD 2231.1±607.2 g，P<0.001）的出生体重。
LMWH 的使用可显著改善胎盘介导 FGR 孕妇的胎儿和新生儿结局，特别是降低宫内胎儿死亡风险。
