单纯首发胎儿生长受限的子痫前期临床特点及围产结局分析

Clinical characteristics and perinatal outcomes of preeclampsia with single first fetal growth restriction

目的 探讨单纯首发胎儿生长受限(fetal growth restriction,FGR)的子痫前期(preeclampsia,PE)临床特点及围产结局。方法 按照纳排标准选取2012年1月至2022年12月在福建省妇幼保健院产检并分娩的4091例PE孕妇,根据是否发生FGR分为FGR组(708例)和非FGR组(3383例),其中FGR组根据FGR和高血压发生的先后顺序分为单纯首发FGR组(438例)和单纯首发高血压伴FGR组(270例),非FGR组中以高血压为首发症状的孕妇纳入单纯首发高血压不伴FGR组(3027例)。分析比较各组孕妇临床特点及围产结局。结果 (1)PE孕妇基线资料:单纯首发FGR组、单纯首发高血压伴FGR组、单纯首发高血压不伴FGR组的孕前体重指数(BMI)分别为21.88±3.18、22.53±3.42、23.23±3.62,高血压家族史比例分别为11.6%、18.9%、14.1%,差异均有统计学意义(P<0.05)。(2)PE孕妇首发症状发生情况:与单纯首发高血压伴FGR组相比,单纯首发FGR组的PE诊断孕周较晚、FGR到出现高血压诊断的间隔时间较长、FGR到出现严重FGR诊断的间隔时间较长、FGR诊断到终止妊娠的间隔时间也较长,差异有统计学意义(P<0.05)。(3)妊娠并发症发生情况:单因素分析显示3组多种妊娠并发症发生率的差异有统计学意义(P<0.05)。多因素回归分析校正混杂因素后,结果显示,单纯首发FGR组与单纯首发高血压伴FGR组的妊娠并发症发生风险并无统计学差异(P>0.05)。但3组多个终止妊娠指征的差异有统计学意义(P<0.05)。(4)新生儿结局情况:单因素分析显示3组多个新生儿结局指标的差异有统计学意义(P<0.05)。多因素回归分析校正混杂因素后,结果显示,与单纯首发FGR组相比,单纯首发高血压伴FGR组新生儿体重仍较轻,差异有统计学意义(P<0.05)。(5)单纯首发FGR组临床特征与新生儿结局的相关性:单因素分析显示3组产检次数、妊娠期水肿、分娩前血压、血红蛋白、血小板、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶、尿酸、白蛋白、血清钙水平的差异有统计学意义(P<0.05)。回归分析显示,产检次数、白蛋白、血清钙水平与新生儿结局指标之间存在正相关;妊娠期水肿、分娩前血压、ALT、AST、乳酸脱氢酶、尿酸水平与新生儿结局指标之间存在负相关(P<0.05)。结论 FGR是PE的临床前期征象,FGR距PE诊断标准全部显现还有较长临床管理时间,有必要加强FGR孕妇血压及PE相关临床表现监测,以延缓或降低发生PE。无论单纯首发FGR组还是单纯首发高血压伴FGR组都容易发生胎盘-胎儿受累及风险,需注意胎盘-胎儿功能监测。FGR首发和高血压首发的PE孕妇具有不同临床特点及围产结局,临床应基于PE孕妇个体的异质性进行个体管理。

Objective To investigate the clinical characteristics and perinatal outcomes of preeclampsia(PE)with sin-gle first fetal growth restriction(FGR).Methods A total of 4091 PE patients were selected,who received examinations and delivered from January 2012 to December 2022 in Fujian Maternal and Child Health Hospital according to the inclusion and exclusion criteria.According to the occurrence of FGR,PE patients were divided into the FGR group(708)and non-FCR group(3383).According to the diagnostic sequence of FGR and hypertension,FGR patients were divided into the first FGR group(438)and the first hypertension with FGR group(270).Patients with hypertension as the first symptom in the non-FGR group were included in the first hypertension without FCR group(3027).The clinical characteristics and perinatal outcomes were compared.Results(1)The pre-pregnancy BMI of first FGR group,first hypertension with FGR group and the first hypertension without FGR group were 21.88±3.18,22.53±3.42,23.23±3.62.The proportion of family history of hypertension was 11.6%,18.9%,14.1%,respectively(P<0.05).(2)Compared with the first hypertension with FCR group,in the first FCR group,the gestational week of PE diagnosis was late;the interval between diagnosis of FGR and hypertension was longer,the internal between diagnosis of FGR and severe FGR was longer,and the interval between diagnosis of FCR and pregnancy termination was also longer(P<0.05).(3)Univariate analysis showed that there were significant differences in the incidence of pregnancy complications among the three groups(P<0.05).Multivariate regression analysis adjusted for confounding factors showed that there was no significant difference in the risk of pregnancy complications between the first FCR group and the first hypertension with FCR group(P>0.05).However,there were significant differences in multiple indicators of pregnancy termination among the three groups(P<0.05).(4)Univariate analysis showed that there were significant differences in neonatal outcomes among the three groups(P<0.05).Multivariate regression analysis adjusted for confounding factors showed that compared with the first FGR group,newborns in the first hypertension with FGR group had lower body weight(P<0.05).(5)In the first FCR group,univeriate analysis showed that the number of prenatal examinations,prenatal edema,the levels of albumin,serum calcium,blood pressure,hemoglobin platlet,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase and uric acid levels before delivery had statistical differences among the 3 groups(P<0.05).Rregression analysis showed that there was a positive correlation between neonatal outcome indexes and the number of prenatal examinations,albumin,serum calcium levels in the first FGR group;while there was a negative correlation between neonatal putcome indexes and prenatal edema,blood pressure,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase and uric acid levels in the first FCR group(P<0.05).Conclusions FGR is a preclinical sign of PE.This study suggests it is a long time for clinical management of FGR before showing all diagnostic criteria of PE.It is necessary to strengthen the monitoring of blood pressure and PE related clinical manifestations in FGR to delay or reduce the occurrence of PE.Both the first FCR group and the first hypertension with FGR group are prone to placenta-fetal involvement and risk,and attention should be paid to placenta-fetal function monitoring.PE patients with first FGR or hypertension have different clinical characteristics and perinatal outcomes,and clinical management should be personalized based on the heterogeneity of PE pregnant women.