胎儿生长受限的预防和治疗

Prevention and treatment of fetal growth restriction

在胎儿生长受限高风险妇女中,健康饮食、能量和蛋白质平衡减少了小于胎龄儿风险。可能营养不良的母亲补充多种微量营养素可降低低出生体重和小于胎龄儿的发病率。小剂量阿司匹林能够降低胎儿生长受限的风险。低分子肝素是否可以预防胎儿生长受限,还需要进一步研究,但也没有观察到低分子肝素的严重不良反应。一旦诊断胎儿生长受限,没有可以改善胎儿生长的治疗方法,没有证据表明卧床休息、营养治疗、氧疗和扩容对胎儿生长受限有治疗作用。目前尚无明确的证据证实低分子肝素在治疗胎儿生长受限方面起作用,但旨在改善子宫胎盘血流灌注不良的潜在疗法在不断研究中,如硝酸盐补充剂、β受体激动剂、西地那非、硫化氢、他汀类药物和褪黑激素等。

In high risk women for fetal growth restriction,healthy diet and balanced energy and protein supplementation reduce the risk of small-for-gestational-age infant.Supplementation of multiple micronutrients in malnourished mothers may reduce the incidence of low-birth-weight and small-for-gestational-age infant.Low-dose aspirin can reduce the risk of fetal growth restriction.Whether low molecular heparin can prevent fetal growth restriction needs further study,but no serious adverse reactions of low molecular heparin have been observed.Once the diagnosis of fetal growth restriction is confirmed,no treatment will improve fetal growth.There is no evidence that bed rest,nutritional supplementation,oxygen therapy or volume expansion has therapeutic effect on fetal growth restriction,and there is no clear evidence that low molecular heparin plays a role in the treatment of fetal growth restriction;however,potential therapies aiming at improving poor uteroplacental perfusion are under research,such as nitrate supplementation,beta-agonists,sildenafil,hydrogen sulfide,statins and melatonin.