Declines in birth weight and fetal growth independent of gestational length.

Declines in birth weight and fetal growth independent of gestational length.
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DOI:
10.1097/aog.0b013e318278d014
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发表时间:
2013-01
影响因子:
7.2
通讯作者:
Oken E
Oken E
中科院分区:
医学2区
文献类型:
--
作者:
Morisaki N;Esplin MS;Varner MW;Henry E;Oken E

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在美国和其他地方,出生体重正在下降,即使在足月单胎婴儿中也是如此,尽管大多数母亲特征的趋势应该有助于增加出生体重。一些研究将这种下降归因于妊娠期长度的同时减少。使用来自Intermountain Healthcare的数据,其中一项成功的计划减少了早期(37 - 38周)选择性分娩的数量,我们检查了2000年7月至2008年12月出生的219,694名单胎婴儿在妊娠37 - 41周时的出生体重,小于胎龄(SGA)和大于胎龄(LGA)的趋势。在这8.5年中,37 - 38周的计划生育出生率下降(9.4%至4.4%),但总体计划生育率增加(29%至34%),出生时的平均胎龄(39.1周)没有变化。平均出生体重(3410 g至3383 g)和LGA(9.0%至7.4%)均下降,而SGA增加(7.5%至8.2%)。在校正了母亲和婴儿特征的多变量分析中,出生体重下降(36 g; 95% CI:31,42),尤其是在37 - 38周出生的婴儿(40 g; 30,49)或有紧急分娩医学指征的婴儿(48 g; 34,63)中。LGA的几率降低(0.84; 0.80,0.88),SGA的几率增加(1.14; 1.08,1.20)。即使在妊娠期长度没有变化的人群中,出生体重和胎儿生长也会下降。不仅妊娠期长度缩短,而且胎儿生长也缩短,这可能是最近广泛观察到的出生体重下降的原因。
Birth weight is decreasing in the US and elsewhere, even among term singletons, although trends in most maternal characteristics should contribute to increased birth weight. Some studies have attributed this decline to the simultaneous decrease in gestational length. Using data from Intermountain Healthcare, where a successful initiative reduced the number of early term (37–38 week) elective deliveries, we examined trends in birth weight, small-for-gestational-age (SGA), and large-for-gestational-age (LGA) among 219,694 singleton infants born July 2000 to December 2008 at 37–41 weeks gestation. Over the 8.5 years, births through scheduled deliveries at 37–38 weeks decreased (9.4% to 4.4%), but overall scheduled deliveries increased (29% to 34%) and mean gestational age at birth (39.1 weeks) did not change. Mean birth weight (3410g to 3383g) and LGA (9.0% to 7.4%) both decreased, whereas SGA increased (7.5% to 8.2%). In multivariable analyses adjusting for maternal and infant characteristics, birth weight decreased (36g; 95% CI: 31, 42), especially among infants born at 37–38 weeks (40g; 30, 49) or that had medical indications for urgent deliveries (48g; 34, 63). Odds of LGA decreased (0.84; 0.80, 0.88) and odds of SGA increased (1.14; 1.08, 1.20). Even in a population where gestation length did not change, birth weight and fetal growth declined. Decrease in not only gestational length but in fetal growth as well is likely to be contributing to the widely observed recent decrease in birth weight.
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