A global reference for fetal-weight and birthweight percentiles
A global reference for fetal-weight and birthweight percentiles
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DOI：
10.1016/s0140-6736(11)60364-4
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发表时间：
2011-05-01
期刊：
影响因子：
168.9
通讯作者：
Merialdi, Mario
中科院分区：
文献类型：
--
作者：
Mikolajczyk, Rafael T.;Zhang, Jun;Merialdi, Mario
背景 全世界不同人群中小于胎龄的定义仍然是一个挑战。基于出生体重的参考对于早产来说是不足的，来自超声估计的参考可能不适用于所有人群，并且个体化参考可能过于复杂而无法在发展中国家使用。我们的目标是创建一个克服这些缺陷并易于适应当地人群的胎儿体重和出生体重的通用参考。方法我们使用 Hadlock 及其同事开发的胎儿体重参考以及 Gardosi 及其同事提出的比例概念，并根据任何当地人群妊娠 40 周时的平均出生体重轻松调整体重参考。为了应用和验证，我们使用了来自非洲、拉丁美洲和亚洲 24 个国家参与 2004-08 年世卫组织孕产妇和围产期健康全球调查（237025 名出生）的数据。我们将我们的参考与 Hadlock 及其同事的参考（非定制）以及 Gardosi 及其同事的参考（个性化）进行了比较。对于每个参考，小于胎龄婴儿与非小于胎龄婴儿的不良围产期结局（死产、新生儿死亡、转至更高级别或特殊护理病房，或阿普加评分在 5 分钟低于 7）的比值比 (OR) 通过多级 Logistic 回归进行估计。小于胎龄婴儿与非小于胎龄婴儿的不良结局的结果 OR 为 1.59（95% CI） 1.53-1.66) 用于非定制胎儿体重参考，而 2.87 (2.73-3.01) 用于我们国家特定参考，2.84 (2.71-2.99) 用于完全个性化参考。 解释 我们的胎儿体重和出生体重百分位数通用参考可以轻松适应当地人群。与非定制胎儿体重参考相比，它具有更好的预测不良围产期结局的能力，并且比个体化参考更易于使用，且不会损失预测能力。
Background Definition of small for gestational age in various populations worldwide remains a challenge. References based on birthweight are deficient for preterm births, those derived from ultrasound estimates might not be applicable to all populations, and the individualised reference can be too complex to use in developing countries. Our aim was to create a generic reference for fetal weight and birthweight that overcame these deficiencies and could be readily adapted to local populations.Methods We used the fetal-weight reference developed by Hadlock and colleagues and the notion of proportionality proposed by Gardosi and colleagues and made the weight reference easily adjustable according to the mean birthweight at 40 weeks of gestation for any local population. For application and validation, we used data from 24 countries in Africa, Latin America, and Asia that participated in the 2004-08 WHO Global Survey on Maternal and Perinatal Health (237025 births). We compared our reference with that of Hadlock and colleagues (non-customised) and with that of Gardosi and colleagues (individualised). For every reference, the odds ratio (OR) of adverse perinatal outcomes (stillbirths, neonatal deaths, referral to higher-level or special care unit, or Apgar score lower than 7 at 5 min) for infants who were small for gestational age versus those who were not was estimated with multilevel logistic regression.Findings OR of adverse outcomes for infants small for gestational age versus those not small for gestational age was 1.59 (95% CI 1.53-1.66) for the non-customised fetal-weight reference compared with 2.87 (2.73-3.01) for our country-specific reference, and 2.84 (2.71-2.99) for the fully individualised reference.Interpretation Our generic reference for fetal-weight and birthweight percentiles can be easily adapted to local populations. It has a better ability to predict adverse perinatal outcomes than has the non-customised fetal-weight reference, and is simpler to use than the individualised reference without loss of predictive ability.