中国双胎妊娠超声估测胎儿体重参考值的开发与验证:一项回顾性队列研究。

IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Jing Yang, Hongzhao Yu, Yangyu Zhao, Zhihao Cheng, Yufeng Du, Pengbo Yuan, Aiqing Zhang, Yang Liu, Xiaoli Gong, Yang Yu, Yixin Li, Xiaoyan You, Nana Huang, Youzhen Zhang, Xiya Sun, Hongbo Qi, Hong-Tian Li, Yuan Wei
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引用次数: 0

摘要

背景:胎儿生长监测对双胎妊娠非常重要。然而,在中国还没有经过临床验证的监测双胎妊娠胎儿生长的工具。本研究旨在为中国双胎妊娠开发并验证绒毛膜特异性超声估测胎儿体重(EFW)生长图表:这项回顾性队列研究纳入了 2007 年 1 月至 2021 年 3 月在一家三级医院分娩的所有双胎妊娠,这些妊娠均有两个胎龄≥34 周的活胎,且无严重产科并发症。参与者分为开发组(2017 年 12 月或之前分娩)和验证组(2018 年 1 月或之后分娩)。在发育集的基础上,使用位置、比例和形状的广义加性模型(GAMLSS)创建了绒毛膜特异性生长图。根据最后一次EFW将验证集中的胎儿分为三组:新建立的双胎图和目前在中国用于双胎妊娠的Hadlock单胎图均显示为小于妊娠年龄(SGA)的胎儿;仅单胎图显示为疑似SGA的胎儿;两种图均未显示为SGA的胎儿。然后比较三组新生儿的预后,包括重症监护室(NICU)住院时间、呼吸系统疾病和神经系统疾病:开发集包括 883 例双胎妊娠,在妊娠 16 至 38 周期间共测量了 6374 例 EFW;验证集包括 801 例双胎妊娠,测量了 7630 例 EFW。在发育集中,单绒毛膜双胎(MCDA)与二绒毛膜双胎(DCDA)相比,从26周开始,EFW明显较低,之后差异逐渐增大,这支持了绒毛膜特异性生长图表的建立。在验证集的 1602 个双胞胎新生儿中,103 个(6.4%)被归入 SGA 组,164 个(10.2%)被归入疑似 SGA 组,1335 个(83.3%)被归入无 SGA 组。呼吸系统疾病和神经系统疾病的发病率在疑似 SGA 组和非 SGA 组之间不相上下,但 SGA 组的发病率明显较高。同时,与无SGA组相比,SGA组双胞胎的新生儿重症监护室住院时间持续较长(差异:0.57,95% CI:0.31-0.83),而疑似SGA组与无SGA组之间无显著差异:结论:胎儿的生长轨迹因绒毛膜性而异,MCDA 双胎的 EFW 从 26 周开始较低。建立绒毛膜特异性生长曲线图可减少SGA的过度诊断,并改善双胎妊娠的胎儿生长监测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Development and validation of an ultrasound-based estimated fetal weight reference for Chinese twin pregnancy: a retrospective cohort study.

Background: Fetal growth monitoring is important for twin pregnancies. However, there has been no clinically validated tool for monitoring fetal growth of twin pregnancies in China. This study aims to develop and validate a chorionicity-specific growth chart of ultrasound estimated fetal weight (EFW) for Chinese twin pregnancies.

Methods: This retrospective cohort study included all twin pregnancies who delivered two live fetuses with gestational age ≥ 34 weeks without severe obstetric complications at a tertiary hospital from January 2007 to March 2021. The participants were divided into a development set (delivered in or before December 2017) and a validation set (delivered in or after January 2018). Chorionicity-specific growth charts were created using the generalized additive models for location, scale, and shape (GAMLSS) based on the development set. The fetuses from the validation set were classified into three groups based on the last EFW: small-for-gestational-age (SGA) indicated by both the newly established twin charts and the Hadlock singleton chart currently used for twin pregnancies in China, suspected SGA indicated by only the singleton chart, and no SGA indicated by either chart. The incidence of neonatal outcomes among the three groups was then compared accordingly, including intensive care unit (NICU) stay length, respiratory diseases, and neurological disorders.

Results: The development set included 883 twin pregnancies and a total of 6374 EFW measurements between 16 and 38 weeks of gestation, and the validation set included 801 twin pregnancies and 7630 EFW measurements. In the development set, monochorionic diamniotic (MCDA) twins had a significantly lower EFW compared to dichorionic diamniotic (DCDA) twins beginning at 26 weeks, with the difference gradually increasing thereafter, supporting the establishment of chorionicity-specific growth charts. Of the 1,602 twin neonates in the validation set, 103 (6.4%) were classified into the SGA group, 164 (10.2%) into the suspected SGA group, and 1335 (83.3%) into the no SGA group. The incidence of respiratory diseases and neurological disorders was comparable between the suspected SGA group and the no SGA group, but apparently higher in the SGA group. Meanwhile, NICU stay lengths were consistently longer for twins in the SGA group compared to the no SGA group (difference: 0.57, 95% CI: 0.31-0.83), with no significant differences observed between the suspected SGA and no SGA groups.

Conclusions: The fetal growth trajectories differed by chorionicity, with a lower EFW for MCDA twins beginning at 26 weeks. The establishment of chorionicity-specific growth chart could reduce overdiagnosis of SGA and improve fetal growth monitoring of twin pregnancies.

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来源期刊
BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth OBSTETRICS & GYNECOLOGY-
CiteScore
4.90
自引率
6.50%
发文量
845
审稿时长
3-8 weeks
期刊介绍: BMC Pregnancy & Childbirth is an open access, peer-reviewed journal that considers articles on all aspects of pregnancy and childbirth. The journal welcomes submissions on the biomedical aspects of pregnancy, breastfeeding, labor, maternal health, maternity care, trends and sociological aspects of pregnancy and childbirth.
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