Outcomes among Neonates after a Diagnosis of Persistent or Transient Fetal Growth Restriction Delivered at Term.
Outcomes among Neonates after a Diagnosis of Persistent or Transient Fetal Growth Restriction Delivered at Term.
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诊断出持续性或暂时性足月胎儿生长受限后新生儿的结果。
DOI：
10.1055/a-2051-3859
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发表时间：
2023
影响因子：
2
通讯作者：
Lewkowitz,AdamK
中科院分区：
文献类型：
--
作者：
Ramos,SebastianZ;Has,Phinnara;Gimovsky,AlexisC;Danilack,ValeryA;Savitz,DavidA;Lewkowitz,AdamK
目的本研究旨在评估在分娩前缓解的短暂性胎儿生长受限 (FGR) 是否与足月时持续存在的单纯性 FGR 具有相似的新生儿发病风险。研究设计这是对 2002 年至 2013 年间在三级护理中心分娩的单胎活产妊娠的医疗记录摘要研究的二次分析。胎儿患有持续性或暂时性 FGR 并在 38 周或以后分娩的患者包括在内。脐动脉多普勒检查异常的患者被排除在外。持续性 FGR 定义为从诊断到分娩，按胎龄计算的估计胎儿体重 (EFW) <第 10 个百分位。瞬时 FGR 定义为至少一次超声检查中的 EFW < 10%，但不是分娩前最后一次超声检查的 EFW。主要结局是新生儿发病率的综合：新生儿重症监护病房入院、5分钟阿普加评分<7、新生儿复苏、动脉pH值<7.1、呼吸窘迫综合征、新生儿短暂性呼吸急促、低血糖、败血症或死亡。使用 Wilcoxon 秩和和 Fisher 精确检验比较基线特征以及产科和新生儿结局。使用对数二项式回归来调整混杂因素。结果 在研究的 777 名患者中，686 名 (88%) 具有持续性 FGR，91 名 (12%) 具有短暂性 FGR。患有短暂性 FGR 的患者更有可能患有较高的体重指数、妊娠期糖尿病、在怀孕早期诊断出 FGR、自然分娩以及晚孕龄分娩。调整混杂因素后，短暂性与持续性 FGR 的综合新生儿结局（相对风险 = 1.03，95% 置信区间 [CI] 0.72, 1.47）没有差异（调整后相对风险 = 0.79，95% CI 0.54, 1.17）。各组间剖宫产或分娩并发症没有差异。 结论 与足月持续存在无并发症 FGR 的新生儿相比，短暂性 FGR 后足月出生的新生儿在综合发病率方面似乎没有差异。
ObjectiveThis study aimed to evaluate whether transient fetal growth restriction (FGR) that resolves prior to delivery confers a similar risk of neonatal morbidity as uncomplicated FGR that persists at term.Study DesignThis is a secondary analysis of a medical record abstraction study of singleton live-born pregnancies delivered at a tertiary care center between 2002 and 2013. Patients with fetuses that had either persistent or transient FGR and delivered at 38 weeks or later were included. Patients with abnormal umbilical artery Doppler studies were excluded. Persistent FGR was defined as estimated fetal weight (EFW) <10th percentile by gestational age from diagnosis through delivery. Transient FGR was defined as EFW <10th percentile on at least one ultrasound, but not on the last ultrasound prior to delivery. The primary outcome was a composite of neonatal morbidity: neonatal intensive care unit admission, Apgar's score <7 at 5 minutes, neonatal resuscitation, arterial cord pH <7.1, respiratory distress syndrome, transient tachypnea of the newborn, hypoglycemia, sepsis, or death. Baseline characteristics and obstetric and neonatal outcomes were compared using Wilcoxon's rank-sum and Fisher's exact test. Log binomial regression was used to adjust for confounders.ResultsOf 777 patients studied, 686 (88%) had persistent FGR and 91 (12%) had transient FGR. Patients with transient FGR were more likely to have a higher body mass index, gestational diabetes, diagnosed with FGR earlier in pregnancy, have spontaneous labor, and deliver at later gestational ages. There was no difference in the composite neonatal outcome (relative risk = 1.03, 95% confidence interval [CI] 0.72, 1.47) for transient versus persistent FGR after adjusting for confounders (adjusted relative risk = 0.79, 95% CI 0.54, 1.17). There were no differences in cesarean delivery or delivery complications between groups.ConclusionNeonates born at term after transient FGR do not appear to have differences in composite morbidity compared with those where uncomplicated FGR persists at term.Key Points