Pregnancy outcomes associated with intrauterine growth restriction
Pregnancy outcomes associated with intrauterine growth restriction
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DOI：
10.1067/mob.2003.384
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发表时间：
2003-06-01
影响因子：
9.8
通讯作者：
Danielsen, B
中科院分区：
文献类型：
--
作者：
Gilbert, WM;Danielsen, B
目的：本研究旨在检查妊娠26至41周分娩的胎儿宫内生长受限（IUGR）的发生率和新生儿结局。研究设计：回顾性审查1994年至1996年加州所有分娩的链接数据库，并向全州卫生和规划发展办公室报告。材料和方法：对与出生和死亡证明相关的产妇和新生儿出院摘要数据库进行检查，包括分娩时的胎龄、IUGR诊断、呼吸窘迫综合征（RDS）、脑室内出血（IVH）、坏死性小肠结肠炎（NEC）、住院时间和住院费用（CHA）。超过140万例单胎分娩按孕周进行检查，并分为是否存在IUGR，然后检查不良新生儿结局。早产新生儿IUGR发生率较孕40周增高（26 = 8.9%，27 = 7.7%，28 = 9.8%，29 = 10.5%，30 = 12.3%，31 = 9.1%，32 = 7.5%，33 = 6.6%，34 = 5.6%，35 = 5.0%，36 = 4.4%，37 = 3.7%，38 = 2.3%，39 = 1.5%，40 = 1.1%）。妊娠28周内，无IUGR的婴儿RDS的发生率高于IUGR的婴儿（无显著性）。从妊娠29周开始，IUGR婴儿的RDS更高。最初不显著，从34周开始，该差异具有统计学显著性。IVH、NEC和住院时间的结果相似。lUGR的存在和结果之间的关系翻转的阈值分别为30周、28周和29周，而分别在34周、35周和30周观察到显著性。CHA总是较高的IUGR的患者，但成为显着较高的29 wk.CONCLUSION：IUGR增加早产，可能是一个重要的危险因素，以检查在妇女谁目前与早产。与不良新生儿结局（RDS、IVH、NEC、CHA）相关的早产在很大程度上不受IUGR的影响，直到妊娠晚期。从那时起，与正常生长的早产儿相比，所有不良结局均增加，这表明需要在妊娠晚期对IUGR进行更密切的监测。
OBJECTIVE: This study was undertaken to examine the incidence of intrauterine growth restriction (IUGR) and neonatal outcomes of pregnancies delivered from 26 to 41 weeks' gestation.STUDY DESIGN: A retrospective review of a linked database of all deliveries in California in 1994 through 1996 that were reported to the Office of Statewide Health and Planning Development.MATERIAL AND METHODS: A database of maternal and neonatal discharge summaries linked to birth and death certificates were examined for gestational age at delivery, diagnosis of IUGR, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), length of stay, and hospital charges (CHA). More than 1.4 million singleton deliveries were examined by week of gestation and separated into the presence or absence of IUGR and then examined for adverse neonatal outcomes.RESULTS: The frequency of IUGR was increased in the preterm newborn infants compared with those at 40 weeks' gestation (26 = 8.9%, 27 = 7.7%, 28 = 9.8%, 29 = 10.5%, 30 = 12.3%, 31 = 9.1%, 32 = 7.5%, 33 = 6.6%, 34 = 5.6%, 35 = 5.0%, 36 = 4.4%, 37 = 3.7%, 38 = 2.3%, 39 = 1.5%, 40 = 1.1%). Up to 28 weeks' gestation, the incidence of RDS was higher for infants without IUGR compared with infants with IUGR (not significant). Starting at 29 weeks' gestation, RDS was higher for infants with IUGR. Initially not significant, this difference was statistically significant starting from 34 weeks. The findings were similar for IVH, NEC, and length of stay. The threshold at which the relationship between the presence of lUGR and the outcome flipped was 30, 28, and 29 weeks, whereas significance was observed at 34, 35, and 30 weeks, respectively. CHA were always higher for those patients with lUGR but became significantly higher after 29 weeks.CONCLUSION: IUGR was increased with prematurity and may represent an important risk factor to check for in women who present with preterm labor. Prematurity associated with adverse neonatal outcomes (RDS, IVH, NEC, CHA) were largely unaffected by IUGR until the third trimester. From then on, all adverse outcomes were increased compared with normally grown premature infants, suggesting a need for closer surveillance for lUGR in the third trimester.