Fetal growth velocity: the NICHD fetal growth studies.
Fetal growth velocity: the NICHD fetal growth studies.
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DOI：
10.1016/j.ajog.2018.05.016
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发表时间：
2018-09
影响因子：
9.8
通讯作者：
Albert PS
中科院分区：
文献类型：
--
作者：
Grantz KL;Kim S;Grobman WA;Newman R;Owen J;Skupski D;Grewal J;Chien EK;Wing DA;Wapner RJ;Ranzini AC;Nageotte MP;Hinkle SN;Pugh S;Li H;Fuchs K;Hediger M;Buck Louis GM;Albert PS
准确识别胎儿生长加速或减少的妊娠具有挑战性，通常基于胎儿体重的横截面百分位估计。纵向生长速度可能会提高识别异常生长的胎儿。我们试图用胎儿生长速度来补充胎儿尺寸标准，开发一个模型来计算任何给定孕周间隔的胎儿生长速度指数，并确定胎儿生长速度与出生体重之间的关联。这是一项前瞻性队列研究，数据收集自12个美国研究中心（2009年至2013年）的1733例非肥胖、低风险妊娠（纳入单胎标准）。在10 w 0 d-13 w 6d进行标准化超声检查后，将每名女性随机分配至4个随访访视计划中的1个，并额外进行5次研究超声检查（目标范围：16-22、24-29、30-33、34-37和38-41周）。研究访视可在目标GA后± 1周进行。超声生物测量包括双顶径、头围、腹围和股骨长度，并计算估计的胎儿体重。我们使用三次样条的线性混合模型，用于固定效应和随机效应，以灵活地模拟超声轨迹。我们以两种方式计算流速比值：（1）连续2周测量值之间的差异（即，每周流速），以及（2）2个胎龄之间临床合理差异的任何2次超声之间的差异（即，流速计算器）。以孕32（±1）周为例，比较胎儿生长速度指数与估计胎儿体重指数的相关性。生长速度计算为该胎龄超声与既往访视之间的估计胎儿生长速度（g/wk）[即，28-32周胎龄：速度=（估计胎儿体重32-28）/（胎龄32-28）]。我们通过估计胎儿体重和估计胎儿体重增长速度是否<第5或≥第5个胎龄（使用χ2）来检查出生体重的差异。胎儿生长速度是非单调的，在妊娠早期加速，双顶径、头围、股骨长和腹围分别在13、14、15和16周达到峰值。双顶径、头围和腹围分别在19-22周、19-21周和27-31周出现第二次加速。估计的胎儿体重增长速度在35周左右达到峰值。胎儿生长速度因人种/种族而略有不同，尽管比较反映了不同胎龄参数的差异。估计的胎儿体重速度曲线与胎儿大小曲线没有高度相关性（Pearson r = 0.40-0.41，P <0.001），这表明这些测量反映了胎儿生长的不同方面，并且速度可以为估计的胎儿体重的单一测量增加额外的信息。在32（SD ± 1）周时，如果估计的胎儿体重增长速度和尺寸均<第5百分位数，则平均出生体重为2550 g;然而，即使尺寸保持<第5百分位数但增长速度≥第5百分位数，出生体重也增加至2867 g，反映了较高生长速度的重要贡献。对于估计的胎儿体重≥第5百分位数，但生长速度<第5百分位数，出生体重较小（分别为3208和3357 g，P <0.001）。我们提供了胎儿生长速度数据，以补充我们以前的工作，胎儿生长尺寸的标准，并开发了一个计算器来计算胎儿生长速度。初步研究结果表明，生长速度增加了额外的信息，而不仅仅是知道胎儿的大小。
Accurately identifying pregnancies with accelerated or diminished fetal growth is challenging and generally based on cross-sectional percentile estimates of fetal weight. Longitudinal growth velocity might improve identification of abnormally grown fetuses. We sought to complement fetal size standards with fetal growth velocity, develop a model to compute fetal growth velocity percentiles for any given set of gestational week intervals, and determine association between fetal growth velocity and birthweight. This was a prospective cohort study with data collected at 12 US sites (2009 through 2013) from 1733 nonobese, low-risk pregnancies included in the singleton standard. Following a standardized sonogram at 10w0d–13w6d, each woman was randomized to 1 of 4 follow-up visit schedules with 5 additional study sonograms (targeted ranges: 16–22, 24–29, 30–33, 34–37, and 38–41 weeks). Study visits could occur ± 1 week from the targeted GA. Ultrasound biometric measurements included biparietal diameter, head circumference, abdominal circumference, and femur length, and estimated fetal weight was calculated. We used linear mixed models with cubic splines for the fixed effects and random effects to flexibly model ultrasound trajectories. We computed velocity percentiles in 2 ways: (1) difference between 2 consecutive weekly measurements (ie, weekly velocity), and (2) difference between any 2 ultrasounds at a clinically reasonable difference between 2 gestational ages (ie, velocity calculator). We compared correlation between fetal growth velocity percentiles and estimated fetal weight percentiles at 4-week intervals, with 32 (±1) weeks’ gestation for illustration. Growth velocity was computed as estimated fetal growth rate (g/wk) between ultrasound at that gestational age and from prior visit [ie, for 28–32 weeks’ gestational age: velocity = (estimated fetal weight 32–28)/(gestational age 32–28)]. We examined differences in birthweight by whether or not estimated fetal weight and estimated fetal weight velocity were <5th or ≥5th percentiles using χ2. Fetal growth velocity was nonmonotonic, with acceleration early in pregnancy, peaking at 13, 14, 15, and 16 weeks for biparietal diameter, head circumference, femur length, and abdominal circumference, respectively. Biparietal diameter, head circumference, and abdominal circumference had a second acceleration at 19–22, 19–21, and 27–31 weeks, respectively. Estimated fetal weight velocity peaked around 35 weeks. Fetal growth velocity varied slightly by race/ethnicity although comparisons reflected differences for parameters at various gestational ages. Estimated fetal weight velocity percentiles were not highly correlated with fetal size percentiles (Pearson r = 0.40–0.41, P < .001), suggesting that these measurements reflect different aspects of fetal growth and velocity may add additional information to a single measure of estimated fetal weight. At 32 (SD ± 1) weeks, if both estimated fetal weight velocity and size were <5th percentile, mean birthweight was 2550 g; however, even when size remained <5th percentile but velocity was ≥5th percentile, birthweight increased to 2867 g, reflecting the important contribution of higher growth velocities. For estimated fetal weight ≥5th percentile, but growth velocity <5th, birthweight was smaller (3208 vs 3357 g, respectively, P < .001). We provide fetal growth velocity data to complement our previous work on fetal growth size standards, and have developed a calculator to compute fetal growth velocity. Preliminary findings suggest that growth velocity adds additional information over knowing fetal size alone.
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流行病学和临床研究中缺少数据的多重归因：潜力和陷阱。
DOI：
10.1136/bmj.b2393
发表时间：
2009-06-29
期刊：
BMJ (Clinical research ed.)
影响因子：
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作者：
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2015-11-21
期刊：
Lancet (London, England)
影响因子：
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作者：
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通讯作者：
Smith GCS
影响因子：
2.5
作者：
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通讯作者：
LARROCHE, JC
影响因子：
7.7
作者：
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DOI：
10.1136/fn.74.1.f10
发表时间：
1996-01-01
影响因子：
4.4
作者：
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通讯作者：
Milani, S