Does one size fit all? The case for ethnic-specific standards of fetal growth.
Does one size fit all? The case for ethnic-specific standards of fetal growth.
复制标题
DOI：
10.1186/1471-2393-8-1
复制
发表时间：
2008-01-08
影响因子：
3.1
通讯作者：
Kramer, Michael S
中科院分区：
文献类型：
--
作者：
Kierans, William J;Joseph, K S;Kramer, Michael S
背景：出生体重与胎龄的比值是胎儿生长发育的一个广泛使用的指标。尽管人们普遍认为有必要对男性和女性制定不同的标准，但胎儿生长中种族差异的生理和病理性质仍存在激烈的争论，尚未得到解决。方法：我们使用1981年至2000年不列颠哥伦比亚省所有死产、活产和确定相关的婴儿死亡来检查中国（n = 4092）、南亚（n = 38670）、第一民族（即北美印第安人）（n = 56097）和其他（n = 731109）出生的胎儿生长和围产期死亡率。我们采用了一种新的基于总危险胎儿的分析方法，比较了基于单一标准和四种种族特定标准的四个种族的围产儿死亡率、平均出生体重和活产婴儿的“显示”（< 10百分位）小胎龄（SGA）。结果：尽管中国和南亚婴儿的平均出生体重较低，SGA率较高（基于单一标准），但他们在整个妊娠期的围产期死亡风险较低。在第一民族的出生中观察到相反的模式：较高的平均出生体重，较低的显示SGA率和较高的围产期死亡风险。然而，当SGA以种族特定标准为基础时，其模式与围产期死亡率观察到的模式一致。结论：围产期死亡率和SGA的一致性，以及基于单一标准时的不一致性，强烈表明所观察到的胎儿生长的种族差异是生理性的，而不是病理性的，并为种族特异性标准提供了强有力的理由。
BACKGROUND: Birth weight for gestational age is a widely-used proxy for fetal growth. Although the need for different standards for males and females is generally acknowledged, the physiologic vs pathologic nature of ethnic differences in fetal growth is hotly debated and remains unresolved.METHODS: We used all stillbirth, live birth, and deterministically linked infant deaths in British Columbia from 1981 to 2000 to examine fetal growth and perinatal mortality in Chinese (n = 40,092), South Asian (n = 38,670), First Nations, i.e., North American Indian (n = 56,097), and other (n = 731,109) births. We used a new analytic approach based on total fetuses at risk to compare the four ethnic groups in perinatal mortality, mean birth weight, and "revealed" (< 10th percentile) small-for-gestational age (SGA) among live births based on both a single standard and four ethnic-specific standards.RESULTS: Despite their lower mean birth weights and higher SGA rates (when based on a single standard), Chinese and South Asian infants had lower perinatal mortality risks throughout gestation. The opposite pattern was observed for First Nations births: higher mean birth weights, lower revealed SGA rates, and higher perinatal mortality risks. When SGA was based on ethnic-specific standards, however, the pattern was concordant with that observed for perinatal mortality.CONCLUSION: The concordance of perinatal mortality and SGA rates when based on ethnic-specific standards, and their discordance when based on a single standard, strongly suggests that the observed ethnic differences in fetal growth are physiologic, rather than pathologic, and make a strong case for ethnic-specific standards.