Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Pediatr Pulmonol. 2024 Jun;59(6):1645-1651. doi: 10.1002/ppul.26964. Epub 2024 Mar 13.
An ultrasound-based diagnosis implies that some fetuses suspected to be growth-restricted (FGR) are discovered at birth to be appropriately grown (appropriate for gestational age [AGA] birth weight, between the 10th and 90th percentile). These fetuses may thus be exposed to unnecessary medical interventions, including early labor induction. In this study, we have evaluated the long-term respiratory health of offspring misclassified as FGR.
A population-based cohort analysis was conducted, including deliveries of AGA singletons between 1991 and 2021 at a tertiary referral hospital. Incidence of morbidity due to various respiratory conditions was compared between AGA offspring with prenatal diagnosis of FGR, and those without a false diagnosis of FGR. The Kaplan-Meier approach was used to estimate cumulative morbidity incidence. The stratified Cox proportional-hazards model was used to control for confounders.
A total of 324,620 deliveries of AGA newborns were included in the analyses; 3249 of them (1.0%) were misclassified prenatally as FGR. The FGR subgroup delivered at an earlier gestational age (36.7 vs. 39.1 weeks, p < .001) and had more than 25% higher incidence of respiratory-related morbidity during childhood (33.2% vs. 26.5%), specifically related to asthma and obstructive sleep apnea (p < .001 for all). A higher cumulative morbidity rate due to respiratory conditions was observed in the Kaplan-Meier survival curve (log-rank p value < .001). This association between FGR and respiratory morbidity was independent of preterm delivery, maternal age, cesarean delivery, and child's birth year (adjusted hazard ratio = 1.14, 95% confidence interval: 1.07-1.21, p < .001), using a Cox proportional hazards model.
AGA newborns misclassified as FGR, are at an increased risk for long-term respiratory morbidity during childhood and adolescence.
基于超声的诊断表明，一些被怀疑生长受限（FGR）的胎儿在出生时被发现发育正常（胎龄适当，出生体重位于第 10 百分位至第 90 百分位之间）。这些胎儿可能因此接受了不必要的医疗干预，包括早产引产。本研究评估了被错误诊断为 FGR 的胎儿的长期呼吸健康状况。
进行了一项基于人群的队列分析，纳入了 1991 年至 2021 年期间在一家三级转诊医院分娩的胎龄适当的单胎儿。比较了产前诊断为 FGR 的 AGA 后代和无 FGR 错误诊断的 AGA 后代发生各种呼吸系统疾病的发病率。采用 Kaplan-Meier 法估计累积发病率。采用分层 Cox 比例风险模型控制混杂因素。
共纳入 324620 例 AGA 新生儿的分娩数据；其中 3249 例（1.0%）产前被错误诊断为 FGR。FGR 亚组的分娩孕周更早（36.7 周与 39.1 周，p<0.001），儿童期呼吸系统相关发病率更高（33.2%与 26.5%，所有均 p<0.001），特别是与哮喘和阻塞性睡眠呼吸暂停相关（所有 p<0.001）。Kaplan-Meier 生存曲线观察到更高的累积呼吸系统疾病发病率（对数秩检验 p 值<0.001）。FGR 与呼吸系统发病率之间的这种关联独立于早产、产妇年龄、剖宫产分娩和儿童出生年份（校正后风险比=1.14，95%置信区间：1.07-1.21，p<0.001），采用 Cox 比例风险模型。
被错误诊断为 FGR 的 AGA 新生儿在儿童和青少年时期患有长期呼吸系统疾病的风险增加。
