胎儿估计体重轨迹与不良妊娠结局间的关联性研究

Association between fetal estimated weight trajectory and abnormal pregnancy outcomes

目的研究胎儿估计体重轨迹与不良妊娠结局间的关联。方法回顾性分析上海市4897名孕妇的产检数据,应用基于组的轨迹模型拟合胎儿估计体重轨迹。再使用Logistic回归模型探究不同胎儿估计体重轨迹与不良妊娠结局间的关联性。结果将4组轨迹分别命名为高水平组(n=301,6.15%)、中高水平组(n=1621,33.10%)、中低水平组(n=2297,46.91%)、低水平组(n=678,13.85%)。胎儿估计体重水平相对高的轨迹组胎儿分娩孕周更早,所对应孕妇年龄更大,孕前平均体质量指数水平更高,差异有统计学意义(P<0.05)。高水平组发生大于胎龄儿、巨大儿及采用剖宫产方式分娩的风险增加(P<0.05);低水平组发生低出生体重、小于胎龄儿的风险增加(P<0.05)。结论胎儿估计体重水平偏高或偏低均会影响胎儿和孕妇的不良妊娠结局发生风险。加强对孕期内胎儿估计体重水平的监测,有助于降低不良妊娠结局的发生率,促进母婴生殖健康。

Objective To investigate the association between fetal estimated weight trajectory and adverse pregnancy outcomes.Methods The obstetric records of 4897 pregnant women in Shanghai were retrospectively analyzed.The group-based trajectory model was used to classify the trajectory of estimated fetal weight.Logistic regression model was used to explore the association between different fetal estimated weight trajectories and adverse pregnancy outcomes.Results Four distinct trajectories were identified as high-level group(n=301,6.15%),medium-high level group(n=1621,33.10%),medium-low level group(n=2297,46.91%),and low-level group(n=678,13.85%).The trajectory group with higher estimated fetal weight had earlier gestational age,older pregnant women and higher average body mass index,and the differences were statistically significant(P<0.05).Compared with the medium-low level group,the high-level group had an increased risk of large for gestational age,macrosomia and cesarean section(P<0.05);the low level group had an increased risk of low birth weight and small for gestational age(P<0.05).Conclusion High and low fetal estimated weight can affect the risk of adverse pregnancy outcomes for both the fetus and their mother.Strengthening the monitoring of the fetal estimated weight during pregnancy will help reduce the incidence of adverse pregnancy outcomes,and promote the reproductive health for mothers and infants.