Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies.
Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies.
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DOI：
10.1016/j.ajog.2015.08.032
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发表时间：
2015-10
影响因子：
9.8
通讯作者：
Grantz KL
中科院分区：
文献类型：
--
作者：
Buck Louis GM;Grewal J;Albert PS;Sciscione A;Wing DA;Grobman WA;Newman RB;Wapner R;D'Alton ME;Skupski D;Nageotte MP;Ranzini AC;Owen J;Chien EK;Craigo S;Hediger ML;Kim S;Zhang C;Grantz KL
胎儿的生长与长期健康有关，但目前还没有适当的标准来早期识别生长不足或过度生长的胎儿。我们试图为四个自我认定的美国种族/民族群体制定当代胎儿生长标准。我们在2009年7月至2013年1月期间从12个社区和围产期中心招募了2，334名低风险单胎妊娠的健康女性进行前瞻性随访。该队列包括：614名（26%）非西班牙裔白人，611名（26%）非西班牙裔黑人，649名（28%）西班牙裔和460名（20%）亚洲人。在第8周至第13周对妇女进行筛查，以确定与假定正常胎儿生长相关的孕产妇健康状况（年龄18-40岁;体重指数19.0-29.9 kg/m2;健康的生活方式和生活条件;低风险病史和产科史）; 92%的招募妇女完成了方案。将女性随机分配到四个超声检查计划中，使用Voluson E8 GE Healthcare进行纵向胎儿测量。在每次访视时进行面对面访谈和人体测量评估;提取医疗记录。1，737名（74%）妇女的胎儿在出生时仍然是低风险的（无并发症妊娠，无异常），其测量结果包括在标准中。使用三次样条线性混合模型估计人种/种族特异性胎儿生长曲线。每个孕周测定估计的胎儿体重和生物特征参数评分（第5、50、95周），并按人种/种族进行比较，调整和不调整母体和社会人口统计学因素。20周后，估计的胎儿体重因人种/种族而存在显著差异。特别是在39周时，白色女性的第5、50和95次体重分别为2790、3505和4402克，西班牙裔女性为2633、3336和4226克，亚裔女性为2621、3270和4078克，黑人女性为2622、3260和4053克（调整后的总体p<0.001）。对于个体参数，按检测顺序列出的人种/种族差异为：肱骨和股骨长度（10周）、腹围（16周）、头围（21周）和双顶径（27周）。仅基于白色组的研究衍生标准错误地将多达15%的非白色胎仔分类为生长受限（估计胎仔体重<第5百分位数）。四组间胎儿生长有显著差异。种族/民族特异性标准提高了评估胎儿生长的精确度。
Fetal growth is associated with long-term health yet no appropriate standards exist for the early identification of under- or over-grown fetuses. We sought to develop contemporary fetal growth standards for four self-identified U.S. racial/ethnic groups. We recruited for prospective follow-up 2,334 healthy women with low-risk, singleton pregnancies from 12 community and perinatal centers between July 2009 and January 2013. The cohort comprised: 614 (26%) non-Hispanic Whites, 611 (26%) non-Hispanic Blacks, 649 (28%) Hispanics, and 460 (20%) Asians. Women were screened at 8w0d to 13w6d for maternal health status associated with presumably normal fetal growth (aged 18–40 years; body mass index 19.0–29.9 kg/m2; healthy lifestyles and living conditions; low-risk medical and obstetrical history); 92% of recruited women completed the protocol. Women were randomized among four ultrasonology schedules for longitudinal fetal measurement using the Voluson E8 GE Healthcare. In-person interviews and anthropometric assessments were conducted at each visit; medical records were abstracted. The fetuses of 1,737 (74%) women continued to be low-risk (uncomplicated pregnancy, absent anomalies) at birth, and their measurements were included in the standards. Racial/ethnic-specific fetal growth curves were estimated using linear mixed models with cubic splines. Estimated fetal weight and biometric parameter percentiles (5th, 50th, 95th) were determined for each gestational week and comparisons made by race/ethnicity, with and without adjustment for maternal and socio-demographic factors. Estimated fetal weight differed significantly by race/ethnicity after 20 weeks. Specifically at 39 weeks, the 5th, 50th, and 95th percentiles were 2790, 3505, and 4402 grams for White, 2633, 3336, and 4226 grams for Hispanic, 2621, 3270, and 4078 grams for Asian, and 2622, 3260, and 4053 grams for Black women (adjusted global p<0.001). For individual parameters, racial/ethnic differences by order of detection were: humerus and femur lengths (10 weeks), abdominal circumference (16 weeks), head circumference (21 weeks), and biparietal diameter (27 weeks). The study-derived standard based solely on the White group erroneously classifies as much as 15% of non-White fetuses as growth-restricted (estimated fetal weight < 5th percentile). Significant differences in fetal growth were found among the four groups. Racial/ethnic-specific standards improve the precision in evaluating fetal growth.