Impairment of growth in fetuses destined to deliver preterm
Impairment of growth in fetuses destined to deliver preterm
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DOI：
10.1067/mob.2001.115865
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发表时间：
2001-08-01
影响因子：
9.8
通讯作者：
Saade, G
中科院分区：
文献类型：
--
作者：
Bukowski, R;Gahn, D;Saade, G
目的：本研究的目的是检验这一假设，胎儿注定要交付早产不达到他们的个人growth potential.Study设计：在一个病例对照设计，44早产分娩小于或等于34周的数据进行了比较与数据的对照组下一个连续的任期交付。入选标准为超声检查确定的妊娠期< 20周且无内科或产科并发症。对于每例胎儿，使用GROW v.2软件生成个体最佳生长曲线，并基于6个独立因素（母体体重、身高、产次、种族、胎儿性别和胎龄）计算出生体重达到生长潜力的百分位数，这些因素通过对40，000例无并发症足月妊娠的多变量logistic回归分析确定为决定胎儿体重的因素。结果：出生体重低于其生长潜力第5、10和25百分位数的胎儿数量在早产组中显著较高（10、13和18）与对照组（2、2和6;分别为P <0.008、P <0.001和P <0.008）相比。病例组和对照组之间定义生长潜力的变量无显著差异;早产和足月妊娠之间低于标准出生体重标准的第5和第10百分位数的胎儿数量无显著差异（3 vs 1和5 vs 2; P = 0.37和P = 0.27）。在早产分娩中，那些在胎膜早破之前早产的孕妇中，胎儿生长潜力> 75百分位数的胎儿明显较少（2比8; P = 0.025）。早产时胎龄较低的胎儿实现了较低的中位数的生长potential.CONCLUSION：一个显着比例的胎儿注定要交付早产不达到其个别的生长潜力相比，在长期交付。这一发现挑战了我们的早产概念和旨在安胎的管理策略。
OBJECTIVE: The objective of this study was to test the hypothesis that fetuses destined to deliver preterm do not reach their individual growth potential.STUDY DESIGN: In a case control design, data on 44 preterm deliveries at less than or equal to 34 weeks were compared with data on a control group of next consecutive term deliveries. Criteria for inclusion were dating by ultrasonography at < 20 weeks and no medical or obstetric complications. For each fetus, GROW v.2 software was used to generate an Individual optimal growth curve and to calculate the percentile of achieved growth potential for birth weight based on 6 independent factors (maternal weight, height, parity, ethnicity, fetal sex, and gestational age) identified as determining fetal weight from multivariate logistic regression analysis of 40,000 uncomplicated term pregnancies. Birth weight percentiles based on standard norms were also calculated for each fetus.RESULTS: The number of fetuses with birth weight below the 5th, 10th, and 25th percentile of their growth potential was significantly higher in the preterm group (10, 13, and 18) compared with that in the control group (2, 2, and 6; P < .008, P < .001, and P < .008, respectively). There were no significant differences in variables defining growth potential between the case and control groups; The number of fetuses below the 5th and 10th percentile based on standard birth weight norms was not significantly different between preterm and term pregnancies (3 vs 1 and 5 vs 2; P = .37 and P = .27). Among preterm deliveries, those preceded by preterm premature rupture of the membranes had significantly fewer fetuses > 75th percentile of their growth potential (2 vs 8; P = .025). Fetuses with lower gestational ages at preterm delivery achieved lower median percentiles of their growth potential.CONCLUSION: A significant proportion of fetuses destined to deliver preterm do not reach their individual growth potential compared with those delivered at term. This finding challenges our concept of preterm delivery and management strategy aimed at tocolysis.