A new customized fetal growth standard for African American women: the PRB/NICHD Detroit study.
A new customized fetal growth standard for African American women: the PRB/NICHD Detroit study.
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DOI：
10.1016/j.ajog.2017.12.229
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发表时间：
2018-03
影响因子：
9.8
通讯作者：
Hassan SS
中科院分区：
文献类型：
--
作者：
Tarca AL;Romero R;Gudicha DW;Erez O;Hernandez-Andrade E;Yeo L;Bhatti G;Pacora P;Maymon E;Hassan SS
对胎儿生长障碍的评估需要一个标准。目前用于评估非裔美国妇女胎儿生长的诺模图要么来自新生儿(而不是胎儿)的生物测量数据，要么没有针对母亲的种族、体重、身高、产次和胎儿性别进行定制。我们试图1)为非裔美国母亲制定一个新的定制胎儿生长标准；2)将这样的标准与现有的三个胎龄划分为小(SGA)或大(LGA)的标准进行比较。一项回溯性队列研究包括来自底特律大都市地区的4183名妇女(4,001名非裔美国人和182名白人)，她们在怀孕14至40周期间接受了超声波检查(每次怀孕的中位数为5次，四分位数范围为3-7次)，并获得了相关的协变量数据。采用纵向分位数回归建立模型，根据孕妇的身高、体重、产次和胎儿性别进行调整，并排除对胎儿体重有显著影响的病理因素，建立定义非裔美国女性胎龄的“正常”估计胎儿体重(EFW)百分位数的模型。由此产生的围产学研究分会/尤尼斯·肯尼迪·施莱弗国家儿童健康和人类发展研究所(以下简称PRB/NICHD)生长标准与其他3个现有标准进行了比较--定制的与妊娠相关的最佳体重(Growth)标准；尤尼斯·肯尼迪·施莱弗国家儿童健康与人类发育研究所(以下简称NICHD)非裔美国人标准；以及多国世界卫生组织(WHO)标准-基于每次怀孕的最后一次可用的超声波检查，用于筛查胎儿的SGA(<；10%)或LGA(>；90%)。第一，高加索新生儿出生40周时的平均出生体重比非裔美国人母亲高133g，男性比女性新生儿高150g；母亲体重、身高和胎次对出生体重有正向影响。第二，纵向EFW分析揭示了胎儿生长的以下特征：(1)所有体重百分位数男性比女性胎儿高约2%；(2)母亲身高对EFW有积极影响，较大的胎儿受到的影响更大(身高每增加10厘米，第95个体重百分位数增加2%)；(3)母体体重和胎次对胎仔体重有正向影响，且随孕周增加而增加，并随体重百分位数的变化而变化。SGA筛查阳性率NICHD非裔美国人标准为7.2%，Growth标准为12.3%，WHO胎儿性别定制标准为13%，PRB/NICHD定制标准为14.4%。在所有标准中，早产胎儿SGA的筛查阳性率至少是足月胎儿的两倍。第四，LGA筛查阳性率为Growth标准8.7%，PRB/NICHD定制标准9.2%，WHO胎儿性别定制标准10.8%，NICHD非裔美国标准12.3%。最后，标准之间的总体一致性最高的是Growth和PRB/NICHD定制标准之间的一致性(Cohen的评分者间协议，kappa=0.85)。我们根据非裔美国人的胎儿数据开发了一种新的定制PRB/NICHD胎儿生长标准，而不假设协变量的影响是成比例的，也没有假设这些影响在所有百分位数的体重上是相等的；我们还提供了一个易于使用的百分位数计算器。与现有标准相比，该标准将更多的胎儿归类为SGA的风险，特别是在早产的胎儿中，但归类为LGA胎儿的数量大致相同。四种生长标准的比较还表明，决定标准之间一致性的最重要因素是它们是否考虑了已知的影响胎儿生长的相同因素。
The assessment of fetal growth disorders requires a standard. Current nomograms for the assessment of fetal growth in African American women have been derived either from neonatal (rather than fetal) biometry data or have not been customized for maternal ethnicity, weight, height, parity, and fetal sex. We sought to 1) develop a new customized fetal growth standard for African American mothers; and 2) compare such a standard to three existing standards for the classification of fetuses as small (SGA) or large (LGA) for gestational age. A retrospective cohort study included 4,183 women (4,001 African American and 182 Caucasian) from the Detroit metropolitan area who underwent ultrasound examinations between 14 and 40 weeks of gestation (the median number of scans per pregnancy was 5, interquartile range 3-7) and for whom relevant covariate data were available. Longitudinal quantile regression was used to build models defining the “normal” estimated fetal weight (EFW) centiles for gestational age in African American women, adjusted for maternal height, weight, parity, and fetal sex, and excluding pathologic factors with a significant effect on fetal weight. The resulting Perinatology Research Branch/Eunice Kennedy Shriver National Institute of Child Health and Human Development (hereinafter, PRB/NICHD) growth standard was compared to 3 other existing standards—the customized gestation-related optimal weight (GROW) standard; the Eunice Kennedy Shriver National Institute of Child Health and Human Development (hereinafter, NICHD) African American standard; and the multinational World Health Organization (WHO) standard—utilized to screen fetuses for SGA (<10th centile) or LGA (>90th centile) based on the last available ultrasound examination for each pregnancy. 1) First, the mean birthweight at 40 weeks was 133g higher for neonates born to Caucasian than to African American mothers and 150g higher for male than female neonates; maternal weight, height, and parity had a positive effect on birthweight.Second, analysis of longitudinal EFW revealed the following features of fetal growth: (1) all weight centiles were about 2% higher for male than for female fetuses; (2) maternal height had a positive effect on EFW, with larger fetuses being affected more (2% increase in the 95th centile of weight for each 10-cm increase in height); and (3) maternal weight and parity had a positive effect on EFW that increased with gestation and varied among the weight centiles. Third, the screen-positive rate for SGA was 7.2% for the NICHD African American standard, 12.3% for the GROW standard, 13% for the WHO standard customized by fetal sex, and 14.4% for the PRB/NICHD customized standard. For all standards, the screen-positive rate for SGA was at least two-fold higher among fetuses delivered preterm than at term.Fourth, the screen-positive rate for LGA was 8.7% for the GROW standard, 9.2% for the PRB/NICHD customized standard, 10.8% for the WHO standard customized by fetal sex, and 12.3% for the NICHD African American standard. Finally, the highest overall agreement among standards was between the GROW and PRB/NICHD customized standards (Cohen’s inter-rater agreement, kappa=0.85). We developed a novel customized PRB/NICHD fetal growth standard from fetal data in an African American population without assuming proportionality of the effects of covariates and also without assuming that these effects are equal on all centiles of weight; we also provide an easy-to-use centile calculator. This standard classified more fetuses as being at risk for SGA compared to existing standards, especially among fetuses delivered preterm, but classified about the same number of LGA fetuses. The comparison among the four growth standards also revealed that the most important factor determining agreement among standards is whether they account for the same factors known to affect fetal growth.
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影响因子：
9.8
作者：
Bukowski, R;Gahn, D;Saade, G
通讯作者：
Saade, G
DOI：
10.7863/ultra.32.6.1083
发表时间：
2013-06-01
期刊：
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
影响因子：
--
作者：
通讯作者：
--
影响因子：
2
作者：
Chauhan, Suneet P.;Beydoun, Hind;Ananth, Cande V.
通讯作者：
Ananth, Cande V.
影响因子：
2
作者：
Costantine MM;Mele L;Landon MB;Spong CY;Ramin SM;Casey B;Wapner RJ;Varner MW;Rouse DJ;Thorp JM Jr;Sciscione A;Catalano P;Caritis SN;Sorokin Y;Peaceman AM;Tolosa JE;Anderson GD;Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, Maryland
通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, Maryland
DOI：
10.1111/j.1471-0528.1994.tb13078.x
发表时间：
1994-02-01
期刊：
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY
影响因子：
--
作者：
CHITTY, LS;ALTMAN, DG;CAMPBELL, S
通讯作者：
CAMPBELL, S