Hertting Emma, Herling Lotta, Lindqvist Pelle G, Wiberg-Itzel Eva
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
PLoS One. 2025 Jun 18;20(6):e0325906. doi: 10.1371/journal.pone.0325906. eCollection 2025.
To investigate the effect of antenatal identification of small for gestational age (SGA) fetuses on perinatal and childhood outcomes, separately analyzing early- and late-onset fetal growth restriction (FGR).
A register-based cohort study of all newborns born SGA, delivered in Stockholm in 2014 and 2017, n = 5499. Ultrasound reports of fetuses born SGA were reviewed and fetuses identified as SGA with ultrasound before birth were further defined as early- or late-onset FGR according to established criteria. Data from the medical chart for maternity and delivery was linked to nationwide Swedish registers. Adverse outcomes for antenatally non-identified SGA/FGR newborns and fetuses identified as early- or late-onset FGR were compared using logistic regression models. A composite outcome, severe adverse outcome, was constructed and defined as at least one of the following: stillbirth, severe newborn distress, severe neonatal outcome, severe childhood outcome. Individual components of the composite outcome were analyzed as secondary outcomes.
Identified early-onset FGR fetuses had an increased risk for severe adverse outcome, compared to non-identified SGA/FGR (aOR 1.81, 95% CI 1.25-2.61), in contrast to late-onset FGR fetuses (aOR 1.14, 95% CI 0.78-1.67). Identified early-onset FGR had a decreased risk of stillbirth (aOR 0.47, 95% CI 0.23-0.96), an increased risk of severe newborn distress (aOR 2.80, 95% CI 1.79-4.39) and severe childhood outcome (aOR 3.00, 95% CI 1.51-5.94), compared to non-identified SGA/FGR. Identified late-onset FGR was only associated with an increased risk of severe childhood outcome (aOR 1.91, 95% CI 1.04-3.52).
Identified early-onset FGR fetuses benefited from identification with a decreased risk of stillbirth at the price of an increased risk for severe newborn and childhood outcomes. For late-onset FGR the advantages were undetectable; identification was associated with an increased risk for severe childhood outcome, while the negative association with stillbirth did not reach significance.
探讨产前识别小于胎龄（SGA）胎儿对围产期和儿童期结局的影响，分别分析早发型和晚发型胎儿生长受限（FGR）。
一项基于登记册的队列研究，对象为2014年和2017年在斯德哥尔摩出生的所有SGA新生儿，n = 5499。回顾SGA出生胎儿的超声报告，根据既定标准，将出生前超声识别为SGA的胎儿进一步定义为早发型或晚发型FGR。将产妇和分娩病历数据与瑞典全国登记册相链接。使用逻辑回归模型比较产前未识别的SGA/FGR新生儿以及识别为早发型或晚发型FGR胎儿的不良结局。构建并定义了一个综合结局，即严重不良结局，定义为以下至少一项：死产、严重新生儿窘迫、严重新生儿结局、严重儿童期结局。将综合结局的各个组成部分作为次要结局进行分析。
与未识别的SGA/FGR相比，识别出的早发型FGR胎儿发生严重不良结局的风险增加（调整后比值比[aOR]为1.81，95%置信区间[CI]为1.25 - 2.61），而晚发型FGR胎儿则不然（aOR为1.14，95% CI为0.78 - 1.67）。与未识别的SGA/FGR相比，识别出的早发型FGR死产风险降低（aOR为0.47，95% CI为0.23 - 0.96），严重新生儿窘迫风险增加（aOR为2.80，95% CI为1.79 - 4.39），严重儿童期结局风险增加（aOR为3.00，95% CI为1.51 - 5.94）。识别出的晚发型FGR仅与严重儿童期结局风险增加相关（aOR为1.91，95% CI为1.04 - 3.52）。
识别出的早发型FGR胎儿从识别中获益，死产风险降低，但代价是严重新生儿和儿童期结局风险增加。对于晚发型FGR，优势不明显；识别与严重儿童期结局风险增加相关，而与死产的负相关未达到显著水平。
