Difference between maternal risk factors for fetal growth restriction and small for gestational age

封面

如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

Objective: This study aimed to compare the maternal gestational risks of insufficient fetal growth (IFG), including small for gestational age (SGA) and fetal growth restriction (FGR).

Materials and methods: This retrospective cohort study was conducted at Perinatal center of N.A. Semashko Republican Clinical Hospital between 2018 and 2023. The study included 611 women with IFG, including 435 with FGR and 176 with SGA. The discriminators of FGR and SGA were studied. Statistical analysis was performed using Statistica 12.0 and Microsoft Excel 2007, and CHAID analysis was conducted using the Classification Trees module.

Results: Potential causes of IFG were hypertensive disorders during pregnancy (41.74%), including preeclampsia (PE) (25.21%), severe (22.59%) or moderate (2.62%), gestational hypertension (GAH) (8.67%), chronic arterial hypertension (CAH) (7.86%), and gestational diabetes mellitus (GDM) (12.77%). The cause of IFG was unknown in 45.49% of women. FGR was more likely to be associated with PE of unknown cause (OR=1.94); SGA was associated with GDM (OR=8.76), GAH (OR=4.38), and CAH (OR=3.93). Prematurity is not obligatory for IFG (24.22%) but is typical for FGR (34.02%). Preterm delivery was associated with severe PE (OR=14.89) and CAH (OR=2.43). The rate of cesarean section for IFG was 55.16% and was associated with FGR (OR=2.95), PE or CAH in FGR, GAH (OR=12.00), and an unknown cause (OR=2.05) in SGA infants. The incidence of iatrogenic prematurity in IFG due to FGR was 86.48 %. Low birth weight (LBW) was more common in the FGR group (OR=6.38).

Conclusion: The FGR and SGA differ in terms of risk factors. The causes of IFG are associated with the risk of iatrogenic prematurity and LBW. Prevention of gestational complications of cardiometabolic origin (hypertensive disorders and GDM) is a measure for preventing IFG. The association of PE with FGR, but not with SGA, confirms the similarity of their pathogenesis and the impossibility of uniform prevention of both IFG variants.

全文:

受限制的访问

作者简介

Arsen Ziyadinov

N.A. Semashko Republican Clinical Hospital, Perinatal Center; S.I. Georgievsky Medical Institute of V.I. Vernadsky Crimean Federal University

编辑信件的主要联系方式.
Email: ars-en@yandex.ru

PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology No. 1 of S.I. Georgievsky Medical Institute, V.I. Vernadsky Crimean Federal University; Obstetrician-Gynecologist at the Perinatal Center of N.A. Semashko Republican Clinical Hospital

俄罗斯联邦, Simferopol; Simferopol

Vladislava Novikova

Peoples' Friendship University of Russia

Email: kafedra-aig@mail.ru

Dr. Med. Sci., Professor of the Department of Obstetrics and Gynecology with the course of Perinatology, Medical Institute 

俄罗斯联邦, Moscow

Victor Radzinsky

Peoples' Friendship University of Russia

Email: kafedra-aig@mail.ru

Dr. Med. Sci., Professor, Corresponding Member of the RAS, Head of the Department of Obstetrics and Gynecology with the course of Perinatology, Medical Institute 

俄罗斯联邦, Moscow

参考

  1. Ashorn P., Black R.E., Lawn J.E., Ashorn U., Klein N., Hofmeyr J. et al. The Lancet Small Vulnerable Newborn Series: science for a healthy start. Lancet. 2020; 396(10253): 743-5. https://dx.doi.org/10.1016/S0140-6736(20)31906-1.
  2. Haksari E.L., Hakimi M., Ismail D. Neonatal mortality in small for gestational age infants based on reference local newborn curve at secondary and tertiary hospitals in Indonesia. BMC Pediatr. 2023; 23(1): 214. https://dx.doi.org/10.1186/s12887-023-04023-z.
  3. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Недостаточный рост плода, требующий предоставления медицинской помощи матери (задержка роста плода). 2022. [Ministry of Health of the Russian Federation. Clinical guidelines. Insufficient fetal growth requiring maternal medical care (fetal growth restriction). 2022. (in Russian)].
  4. Colella M., Frérot A., Novais A.R.B., Baud O. Neonatal and long-term consequences of fetal growth restriction. Curr. Pediatr. Rev. 2018; 14(4): 212-8. https://dx.doi.org/10.2174/1573396314666180712114531.
  5. Gordijn S.J., Beune I.M., Ganzevoort W. Building consensus and standards in fetal growth restriction studies. Best Pract. Res. Clin. Obstet. Gynaecol. 2018; 49:117-26. https://dx.doi.org/10.1016/j.bpobgyn.2018.02.002.
  6. Osuchukwu O.O., Reed D.J. Small for gestational age. 2022. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
  7. Melamed N., Baschat A., Yinon Y., Athanasiadis A., Mecacci F., Figueras F. et al. FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction. Int. J. Gynaecol. Obstet. 2021; 152 Suppl 1(Suppl 1): 3-57. https://dx.doi.org/10.1002/ijgo.13522.
  8. McCowan L.M., Figueras F., Anderson N.H. Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am. J. Obstet. Gynecol. 2018; 218(2S): S855-S868. https://dx.doi.org/10.1016/j.ajog.2017.12.004.
  9. Galvão R.B., Souza R.T., Vieira M.C., Pasupathy D., Mayrink J., Feitosa F.E. et al.; Preterm SAMBA study group. Performances of birthweight charts to predict adverse perinatal outcomes related to SGA in a cohort of nulliparas. BMC Pregnancy Childbirth. 2022; 22(1): 615. https://dx.doi.org/10.1186/s12884-022-04943-1.
  10. Konstantyner T., Areco K.C.N., Bandiera-Paiva P., Marinonio A.S.S., Kawakami M.D., Balda R.C.X. et al. The burden of inappropriate birth weight on neonatal survival in term newborns: a population-based study in a middle-income setting. Front. Pediatr. 2023; 11: 1147496. https://dx.doi.org/10.3389/fped.2023.1147496.
  11. Hokken-Koelega A.C.S., van der Steen M., Boguszewski M.C.S., Cianfarani S., Dahlgren J., Horikawa R. et al. International Consensus Guideline on small for gestational age: etiology and management from infancy to early adulthood. Endocr. Rev. 2023; 44(3): 539-65. https://dx.doi.org/10.1210/endrev/bnad002.
  12. Yang L., Feng L., Huang L., Li X., Qiu W., Yang K. et al. Maternal factors for intrauterine growth retardation: systematic review and meta-analysis of observational studies. Reprod. Sci. 2023; 30(6): 1737-45. https://dx.doi.org/10.1007/s43032-021-00756-3.
  13. Mansfield R., Cecula P., Pedraz C.T., Zimianiti I., Elsaddig M., Zhao R. et al. Impact of perinatal factors on biomarkers of cardiovascular disease risk in preadolescent children. J. Hypertens. 2023; 41(7): 1059-67. https://dx.doi.org/10.1097/HJH.0000000000003452.
  14. Шитиков В.К., Мастицкий С.Э. Классификация, регрессия и другие алгоритмы Data Mining с использованием R. 2017; 351 с. Доступно по: https://github.com/ranalytics/data-mining [Shitikov V.K., Mastitsky S.E. Classification, regression and other Data Mining algorithms using R. 2017; 351 p. (in Russian). Available at: https://github.com/ranalytics/data-mining].
  15. Дружилов М.А., Кузнецова Т.Ю., Гаврилов Д.В., Гусев А.В. Верификация субклинического каротидного атеросклероза в рамках риск-стратификации при избыточном весе и ожирении: роль методов машинного обучения в формировании диагностического алгоритма. Кардиоваскулярная терапия и профилактика. 2022; 21(7): 3222. [Druzhilov M.A., Kuznetsova T.Yu., Gavrilov D.V., Gusev A.V. Verification of subclinical carotid atherosclerosis as part of risk stratification in overweight and obesity: the role of machine learning in the development of a diagnostic algorithm. Cardiovascular Therapy and Prevention. 2022; 21(7): 3222. (in Russian)]. https://dx.doi.org/10.15829/1728-8800-2022-3222.
  16. Thong E.P., Ghelani D.P., Manoleehakul P., Yesmin A., Slater K., Taylor R. et al. Optimising cardiometabolic risk factors in pregnancy: a review of risk prediction models targeting gestational diabetes and hypertensive disorders. J. Cardiovasc. Dev. Dis. 2022; 9(2): 55. https://dx.doi.org/10.3390/jcdd9020055.
  17. Sharma D., Shastri S., Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects. Clin. Med. Insights Pediatr. 2016; 10: 67-83. https://dx.doi.org/10.4137/CMPed.S40070.
  18. WHO. Statement on caesarean section rates. Geneva: World Health Organization, 2015. URL: http://www.who.int/reproductivehealth/ publications/maternal_perinatal_health/cs-statement/en/.
  19. Valencia C.M., Mol B.W., Jacobsson B.; FIGO Working Group for Preterm Birth. FIGO good practice recommendations on modifiable causes of iatrogenic preterm birth. Int. J. Gynaecol. Obstet. 2021; 155(1): 8-12. https://dx.doi.org/10.1002/ijgo.13857.
  20. Sławek-Szmyt S., Kawka-Paciorkowska K., Ciepłucha A., Lesiak M., Ropacka-Lesiak M. Preeclampsia and fetal growth restriction as risk factors of future maternal cardiovascular disease-A review. J. Clin. Med. 2022; 11(20): 6048. https://dx.doi.org/10.3390/jcm11206048.
  21. Абрамова М.Ю., Пономаренко И.В., Орлова В.С., Батлуцкая И.В., Ефремова О.А., Сорокина И.Н., Чурносов М.И. Генетические маркеры риска развития задержки роста плода у беременных с преэклампсией. Медицинский совет. 2023; 17(6): 150-6. [Abramova M.Yu., Ponomarenko I.V., Orlova V.S., Batlutskaya I.V., Efremova O.A., Sorokina I.N., Churnosov M.I. Genetic markers of the risk of fetal growth retardation in pregnant women with preeclampsia. Medical Council. 2023; 17(6): 150-6. (in Russian)]. https://dx.doi.org/10.21518/ms2022-006.
  22. Гуменюк Е.Г., Ившин А.А., Болдина Ю.С. Поиск предикторов задержки роста плода: от сантиметровой ленты до искусcтвенного интеллекта. Акушерство и гинекология. 2022; 12: 18-24. [Gumenyuk E.G., Ivshin A.A., Boldina Yu.S. Search for predictors of fetal growth retardation: from centimeter tape to artificial intelligence. Obstetrics and Gynecology. 2022; (12): 18-24. (in Russian)]. https://dx.doi.org/10.18565/aig.2022.185.

补充文件

附件文件
动作
1. JATS XML
下载
2. Fig. 1. Structure of risk factors for fetal growth failure: a) in the cohort; b) in the groups

下载 (346KB)
索引源数据
3. Fig. 2. Interrelated complications of gestation with UUI in principle (a); with VTE or IHF (b)

下载 (358KB)
索引源数据
4. Fig. 3. Gestational age at delivery: a - in cohort: b, c - in groups

下载 (310KB)
索引源数据
5. Fig. 4. Frequency of PR in the cohort according to gestational age

下载 (174KB)
索引源数据
6. Fig. 5. Structure of causes and frequency (%) of PPD in prematurity (a); method of delivery according to the cause of PPD and its type (b)

下载 (247KB)
索引源数据
7. Fig. 6. Indications for CS (a) and complications of vaginal delivery (b)

下载 (254KB)
索引源数据
8. Fig. 7. Indications for CS (a) and complications of vaginal delivery (b) according to the cause of IUGR

下载 (265KB)
索引源数据
9. Fig. 8. Methods of delivery in prematurity

下载 (153KB)
索引源数据
10. Fig. 9. Distribution of newborns: a) low birth weight by variant and cause of UUI; b) by specific treatment and cause of UUI

下载 (315KB)
索引源数据
11. Fig. 10. Prognostic significance of predictors of PPH or IHD: a) in the cohort; b) in CS; c) in vaginal delivery

下载 (480KB)
索引源数据
12. Fig. 11. Predictive significance of predictors of the volume of medical care for a newborn baby

下载 (111KB)
索引源数据

版权所有 © Bionika Media, 2024
##common.cookie##