Center for Cerebral Palsy, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Obstetrics and Gynecology, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark.
Ultrasound Obstet Gynecol. 2024 Jun;63(6):764-771. doi: 10.1002/uog.27610.
To analyze perinatal risks associated with three distinct scenarios of fetal growth trajectory in the latter half of pregnancy compared with a reference group.
This cohort study included women with a singleton pregnancy that delivered between 32 + 0 and 41 + 6 weeks' gestation and had two or more ultrasound scans, at least 4 weeks apart, from 18 + 0 weeks. We evaluated three different scenarios of fetal growth against a reference group, which comprised appropriate-for-gestational-age fetuses with appropriate forward-growth trajectory. The comparator growth trajectories were categorized as: Group 1, small-for-gestational-age (SGA) fetuses (estimated fetal weight (EFW) or abdominal circumference (AC) persistently < 10 centile) with appropriate forward growth; Group 2, fetuses with decreased growth trajectory (decrease of ≥ 50 centiles) and EFW or AC ≥ 10 centile (i.e. non-SGA) at their final ultrasound scan; and Group 3, fetuses with decreased growth trajectory and EFW or AC < 10 centile (i.e. SGA) at their final scan. The primary outcome was overall perinatal mortality (stillbirth or neonatal death). Secondary outcomes included stillbirth, delivery of a SGA infant, preterm birth, emergency Cesarean section for non-reassuring fetal status and composite severe neonatal morbidity. Associations were analyzed using logistic regression.
The final study cohort comprised 5319 pregnancies. Compared to the reference group, the adjusted odds of perinatal mortality were increased significantly in Group 2 (adjusted odds ratio (aOR), 4.00 (95% CI, 1.36-11.22)) and Group 3 (aOR, 7.71 (95% CI, 2.39-24.91)). Only Group 3 had increased odds of stillbirth (aOR, 5.69 (95% CI, 1.55-20.93)). In contrast, infants in Group 1 did not have significantly increased odds of demise. The odds of a SGA infant at birth were increased in all three groups compared with the reference group, but was highest in Group 1 (aOR, 111.86 (95% CI, 62.58-199.95)) and Group 3 (aOR, 40.63 (95% CI, 29.01-56.92)). In both groups, more than 80% of infants were born SGA and nearly half had a birth weight < 3 centile. Likewise, the odds of preterm birth were increased in all three groups compared with the reference group, being highest in Group 3, with an aOR of 4.27 (95% CI, 3.23-5.64). Lastly, the odds of composite severe neonatal morbidity were increased in Groups 1 and 3, whereas the odds of emergency Cesarean section for non-reassuring fetal status were increased only in Group 3.
Assessing the fetal growth trajectory in the latter half of pregnancy can help identify infants at increased risk of perinatal mortality and birth weight < 3 centile for gestation. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
分析妊娠后半期三种不同胎儿生长轨迹与参考组相比的围产儿风险。
本队列研究纳入了单胎妊娠且在 32+0 至 41+6 孕周之间分娩的孕妇，且在 18+0 周后至少有两次超声检查，两次检查至少相隔 4 周。我们将三种不同的胎儿生长情况与参考组进行了比较，参考组为具有适当向前生长轨迹的适合胎龄胎儿。比较的生长轨迹分为三组：第 1 组为小胎龄儿（SGA）（估计胎儿体重（EFW）或腹围（AC）持续<第 10 百分位数）但具有适当的向前生长；第 2 组为生长轨迹下降（下降≥第 50 百分位数）且最终超声检查时 EFW 或 AC≥第 10 百分位数（即非 SGA）的胎儿；第 3 组为生长轨迹下降且最终超声检查时 EFW 或 AC<第 10 百分位数（即 SGA）的胎儿。主要结局是总体围产儿死亡率（死产或新生儿死亡）。次要结局包括死产、SGA 婴儿分娩、早产、因胎儿情况不佳而行紧急剖宫产术以及复合严重新生儿并发症。使用逻辑回归分析相关性。
最终的研究队列包括 5319 例妊娠。与参考组相比，第 2 组（调整后的优势比（aOR），4.00（95%CI，1.36-11.22））和第 3 组（aOR，7.71（95%CI，2.39-24.91））的围产儿死亡率显著增加。只有第 3 组的死产风险增加（aOR，5.69（95%CI，1.55-20.93））。相比之下，第 1 组的婴儿死亡风险没有显著增加。与参考组相比，所有三组的 SGA 婴儿出生率均增加，但第 1 组（aOR，111.86（95%CI，62.58-199.95））和第 3 组（aOR，40.63（95%CI，29.01-56.92））的出生体重 SGA 婴儿的风险最高。两组中，超过 80%的婴儿出生体重为 SGA，近一半的婴儿出生体重<第 3 百分位。同样，与参考组相比，所有三组的早产风险均增加，第 3 组最高，aOR 为 4.27（95%CI，3.23-5.64）。最后，第 1 组和第 3 组的复合严重新生儿并发症风险增加，而第 3 组的紧急剖宫产术以改善胎儿状况的风险增加。
评估妊娠后半期的胎儿生长轨迹有助于识别围产儿死亡率和出生体重<胎龄第 3 百分位的风险增加的婴儿。 © 2024 年国际妇产科超声学会。
