目的 探讨单胎妊娠胎儿生长受限(FGR)的危险因素及其对胎儿结局的影响。方法 回顾性分析2018-01至2022-12于解放军总医院第一医学中心分娩的375例单胎妊娠FGR孕产妇临床资料,设为研究组,另通过分层抽样选取同期单胎妊娠非FGR孕产妇375例设为对照组。比较两组母体因素、胎儿附属物因素、分娩情况和胎儿结局,并通过多因素logistic回归分析探究FGR危险因素,分析FGR的胎儿结局。结果 胎盘异常(OR=6.259,95%CI:3.263~12.004)、脐带异常(OR=7.500,95%CI:3.034~18.542)、羊水异常(OR=6.366,95%CI:1.050~38.606)、胎盘面积减少(OR=0.989,95%CI:0.986~0.992)、高血压(OR=4.100,95%CI:2.087~8.055)、贫血(OR=2.387,95%CI:1.271~4.485)、BMI增加(OR=1.076,95%CI:1.020~1.135)是FGR发生的独立危险因素,分娩孕周越大(OR=0.842,95%CI:0.728~0.975),发生FGR的可能性越小;研究组早产率(26.7%)、剖宫产率(49.6%)、胎儿窘迫发生率(18.1%)和胎儿病死率(2.9%)均高于对照组(1.3%、35.5%、5.1%、0%;P<0.05)。结论 FGR发生的危险因素较多且相互作用,增加了胎儿不良结局的风险,应加强FGR早期筛查、孕期监测及妊娠期合并症防治,改善母婴结局。
Abstract
Objective To explore the risk factors of fetal growth restriction (FGR) in single pregnancy and its influence on fetal outcomes. Methods The clinical data of 375 single pregnancies with FGR admitted to the First Medical Center of PLA General Hospital from January 2018 to December 2022 were retrospectively analyzed and set as the study group, and 375 clinical data of single pregnancies without FGR were also collected through stratified sampling and set as the control group. Maternal factors, fetal accessory factors, delivery modes and fetal outcomes were compared between the two groups, the risk factors of FGR were explored by multivariate logistic regression analysis, and the fetal outcomes of FGR were analyzed. Results Placenta abnormities [OR(95%CI): 6.259(3.263-12.004)], umbilical cord abnormities [7.500(3.034-18.542)], amniotic fluid abnormities [6.366 (1.050-38.606)], decreased placental area [0.989(0.986-0.992)], hypertension [4.100(2.087-8.055)], anemia [2.387(1.271-4.485)] and increased maternal BMI [1.076 (1.020-1.135)] were independent risk factors for FGR, and the greater the delivery week [0.842(0.728-0.975)], the lower the probability of FGR. The rate of preterm delivery (26.7%), cesarean section (49.6%), fetal distress (18.1%) and fetal mortality (2.9%) in the study group were significantly higher than those in the control group (1.3%, 35.5%, 5.1%, 0%;P<0.05). Conclusions The risk factors for FGR are numerous and interactive which increases the risk of adverse fetal outcomes. Early screening of FGR, monitoring during pregnancy, prevention and treatment of pregnancy complications during pregnancy should be strengthened to improve maternal and fetal outcomes.
关键词
胎儿生长受限 /
危险因素 /
胎儿附属物 /
妊娠高血压 /
胎儿结局
Key words
fetal growth restriction /
risk factors /
fetal appendages /
gestational hypertension /
fetal outcome
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基金
军队计生专项课题(20JSZ11),国家重点研发计划(2021YFC1005301,2022YFC2703705)
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