全球胎儿生长受限指南:求同存异

Global guidelines for fetal growth restriction:seeking common ground while respecting differences

由于诊断标准不一致,“胎儿生长受限(fetal growth restriction,FGR)”常与“小于胎龄儿(small for gestational age,SGA)”混用。但SGA新生儿通常仅表现为体形偏小,而FGR胎儿发生近、远期并发症的风险则相对较高。近年来超声技术、多组学联用和人工智能等领域的发展有助于揭示FGR的诊断及病因机制,但FGR仍面临检出率低、诊断标准不统一和防治手段欠缺等挑战。本文对比各主要学术组织对FGR的定义、风险分级、早期筛查与诊断、遗传咨询和产前诊断、产前监测、终止妊娠及预防等方面的观点,并进行适度评价,以有助于推进现有的诊断与孕期管理,并有望为未来的研究提供方向,实现对FGR的早期识别和精准诊断。

Due to inconsistent diagnostic criteria,the term"fetal growth restriction(FGR)"is often confused with"small for gestational age".However,SGA newborns are typically just smaller in size,whereas FGR is associated with higher risks of short-and long-term complications.Recent advancements in ultrasound technology,multi-omics integration,and artificial intelligence technology have aided in the diagnosis and elucidation of the etiological mechanisms of FGR.Nonetheless,challenges such as low positive detection rates,inconsistent diagnostic standards,and a lack of preventive and therapeutic measures remain.This article compares the definitions,risk stratification,early screening and diagnosis,genetic counseling,and prenatal diagnosis,prenatal monitoring,pregnancy termination,and prevention strategies of FGR as proposed by different academic organizations.It also provides a moderate evaluation to help advance current diagnostic and pregnancy management strategies,offering directions for future research to achieve early identification and precise diagnosis of FGR.