Tanner Darren, Lavista Ferres Juan M, Mitchell Edwin A
AI for Health, AI for Good Research Lab, Microsoft Corporation, Redmond, WA, USA.
Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.
Sci Rep. 2024 Mar 12;14(1):6002. doi: 10.1038/s41598-024-56572-7.
In the United States the rate of stillbirth after 28 weeks' gestation (late stillbirth) is 2.7/1000 births. Fetuses that are small for gestational age (SGA) or large for gestational age (LGA) are at increased risk of stillbirth. SGA and LGA are often categorized as growth or birthweight ≤ 10th and ≥ 90th centile, respectively; however, these cut-offs are arbitrary. We sought to characterize the relationship between birthweight and stillbirth risk in greater detail. Data on singleton births between 28- and 44-weeks' gestation from 2014 to 2015 were extracted from the US Centers for Disease Control and Prevention live birth and fetal death files. Growth was assessed using customized birthweight centiles (Gestation Related Optimal Weight; GROW). The analyses included logistic regression using SGA/LGA categories and a generalized additive model (GAM) using birthweight centile as a continuous exposure. Although the SGA and LGA categories identified infants at risk of stillbirth, categorical models provided poor fits to the data within the high-risk bins, and in particular markedly underestimated the risk for the extreme centiles. For example, for fetuses in the lowest GROW centile, the observed rate was 39.8/1000 births compared with a predicted rate of 11.7/1000 from the category-based analysis. In contrast, the model-predicted risk from the GAM tracked closely with the observed risk, with the GAM providing an accurate characterization of stillbirth risk across the entire birthweight continuum. This study provides stillbirth risk estimates for each GROW centile, which clinicians can use in conjunction with other clinical details to guide obstetric management.
在美国，孕28周后（晚期死产）的死产率为每1000例出生中有2.7例。小于胎龄儿（SGA）或大于胎龄儿（LGA）的死产风险增加。SGA和LGA通常分别被归类为生长或出生体重≤第10百分位数和≥第90百分位数；然而，这些临界值是任意设定的。我们试图更详细地描述出生体重与死产风险之间的关系。从美国疾病控制与预防中心的活产和胎儿死亡档案中提取了2014年至2015年孕28至44周单胎分娩的数据。使用定制的出生体重百分位数（妊娠相关最佳体重；GROW）评估生长情况。分析包括使用SGA/LGA类别进行逻辑回归以及使用出生体重百分位数作为连续暴露变量的广义相加模型（GAM）。尽管SGA和LGA类别识别出了有死产风险的婴儿，但分类模型对高风险区间内的数据拟合不佳，特别是明显低估了极端百分位数的风险。例如，对于处于最低GROW百分位数的胎儿，观察到的发生率为每1000例出生中有39.8例，而基于类别的分析预测发生率为每1000例出生中有11.7例。相比之下，GAM模型预测的风险与观察到的风险密切相关，GAM能够准确描述整个出生体重连续区间内的死产风险。本研究提供了每个GROW百分位数的死产风险估计值，临床医生可将其与其他临床细节结合使用，以指导产科管理。
