Prediction and prevention of small-for-gestational-age neonates: evidence from SPREE and ASPRE
Prediction and prevention of small-for-gestational-age neonates: evidence from SPREE and ASPRE
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DOI：
10.1002/uog.19077
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发表时间：
2018-07-01
影响因子：
7.1
通讯作者：
Nicolaides, K. H.
中科院分区：
文献类型：
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作者：
Tan, M. Y.;Poon, L. C.;Nicolaides, K. H.
目的探讨妊娠早期筛查先兆子痫(PE)对分娩小胎龄(SGA)新生儿的预测作用及预防性应用阿司匹林预防SGA的效果。在SPREE中，我们调查了怀孕11-13周时结合母体特征和生物标记物进行PE筛查的表现。在ASPRE中，通过联合筛查确定为早产儿PE高危人群的单胎妊娠妇女(100人中有1人)参加了阿司匹林(从怀孕11-14周到36周，每天150毫克)与安慰剂的对比试验。在这项研究中，我们使用ASPRE试验的数据来评估阿司匹林对出生体重为胎龄第10、5和3百分位数的SGA发生率的影响。结果在SPREE中，结合母体因素、平均动脉压、子宫动脉搏动指数和血清胎盘生长因子筛查早产儿PE，发现SGA是高危人群，孕37周(早产儿)和32周(早产儿)分别占SGA新生儿的46%和56%，筛查总阳性率为12.2%(2014/16451)。在ASPRE试验中，在妊娠37周出生的婴儿中，使用阿司匹林使SGA<；10百分位数的总体发生率降低了约40%，在妊娠32周出生的婴儿中，使用阿司匹林降低了约70%。
Objectives To examine the effect of first-trimester screening for pre-eclampsia (PE) on the prediction of delivering a small-for-gestational-age (SGA) neonate and the effect of prophylactic use of aspirin on the prevention of SGA.Methods The data for this study were derived from two multicenter studies. In SPREE, we investigated the performance of screening for PE by a combination of maternal characteristics and biomarkers at 11-13 weeks' gestation. In ASPRE, women with a singleton pregnancy identified by combined screening as being at high risk for preterm PE (> 1 in 100) participated in a trial of aspirin (150 mg/day from 11-14 until 36 weeks' gestation) compared to placebo. In this study, we used the data from the ASPRE trial to estimate the effect of aspirin on the incidence of SGA with birth weight < 10th, < 5th and < 3rd percentile for gestational age. We also used the data from SPREE to estimate the proportion of SGA in the pregnancies with a risk for preterm PE of > 1 in 100.Results In SPREE, screening for preterm PE by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index and serum placental growth factor identified a high-risk group that contained about 46% of SGA neonates < 10th percentile born at < 37 weeks' gestation (preterm) and 56% of those born at < 32 weeks (early); the overall screen-positive rate was 12.2% (2014 of 16 451 pregnancies). In the ASPRE trial, use of aspirin reduced the overall incidence of SGA< 10th percentile by about 40% in babies born at < 37 weeks' gestation and by about 70% in babies born at < 32 weeks; in babies born at