澳大利亚莫纳什大学Mary-Ann Davey团队分析了疑似胎儿生长受限的医源性分娩与儿童学业成绩的相关性。该研究于2021年7月13日发表于《美国医学会杂志》上。

及时分娩疑似胎儿生长受限（FGR）的婴儿是防止死产和减少早产之间的权衡，特别是因为许多疑似FGR的婴儿生长正常。

为了探讨疑似FGR医源性分娩与儿童学业成绩的关系，研究组进行了一项回顾性全人群队列研究，将2003年1月1日至2013年12月31日孕32周及以上分娩的围产期数据与澳大利亚维多利亚州预备学校以及三、五、七年级的发育情况和教育考试分数联系起来。后续工作于2019年结束。

分析这些儿童是否疑似FGR，是否有医源性分娩（定义为早产引产或分娩前剖宫产），以及是否有小于胎龄儿（SGA）。主要结局为在入学的5个发育领域中，有2个或更多领域的共同研究结果处于最低10%，在三、五、七年级的5个教育领域中，有2个或更多领域的共同研究结果低于国家最低标准。

出生人口共包括705937名婴儿，出生时平均妊娠39.1周，平均出生体重3426克。181902名儿童有发育结果，425717名儿童有教育成绩。与未疑似FGR的重度SGA（出生体重低于第3百分位）婴儿相比（平均妊娠39.4周），因疑似FGR而分娩的重度SGA婴儿出生更早（37.9周）。因疑似FGR而分娩的儿童在入学时发育不良的风险也显著增加（16.2%与12.7%），校正优势比为1.36，三年级、五年级和七年级时的教育考试成绩较差，校正优势比为1.33。对于生长正常（出生体重高于第10百分位）的婴儿，疑似FGR的出生时间（平均妊娠38.0周）早于未疑似FGR（39.1周）婴儿，但发育不良的风险无显著差异，三年级、五年级和七年级时的教育考试成绩亦无显著差异。

研究结果表明，与未疑似FGR的严重SGA婴儿相比，疑似FGR的严重SGA婴儿的医源性分娩与发育不良和较差的学业成绩相关，但怀疑FGR的正常生长婴儿医源性分娩却对发育和学业成绩无影响。

附：英文原文

Title: Association Between Iatrogenic Delivery for Suspected Fetal Growth Restriction and Childhood School Outcomes

Author: Roshan John Selvaratnam, Euan Morrison Wallace, Rory Wolfe, Peter John Anderson, Mary-Ann Davey

Issue&Volume: 2021/07/13

Abstract:

Importance  Timely delivery of infants suspected of having fetal growth restriction (FGR) is a balance between preventing stillbirth and minimizing prematurity, particularly because many infants with suspected FGR have normal growth.

Objective  To explore the association between iatrogenic delivery for suspected FGR and childhood school outcomes.

Design, Setting, and Participants  A retrospective whole-population cohort study linking perinatal data from births 32 weeks’ or more gestation between January 1, 2003, to December 31, 2013, to developmental and educational test scores at preparatory school, and at school grades 3, 5, and 7 in Victoria, Australia. Follow-up was concluded in 2019.

Exposures  Suspicion or nonsuspicion of FGR, presence or absence of iatrogenic delivery (defined as early induction of labor or cesarean delivery prior to labor) for suspected FGR, and presence or absence of small for gestational age (SGA).

Main Outcomes and Measures  The coprimary outcomes were being in the bottom 10th percentile on 2 or more of 5 developmental domains at school entry and being below the national minimum standard on 2 or more of 5 educational domains in grades 3, 5, or 7.

Results  In the birth population of 705937 infants, the mean gestation at birth was 39.1 (SD, 1.5) weeks and the mean birth weight was 3426 (SD, 517) grams. The birth population linked to 181902 children with developmental results and 425717 children with educational results. Compared with infants with severe SGA (birth weight <3rd percentile) not suspected of having FGR, infants with severe SGA delivered for suspected FGR were born earlier (mean gestation, 37.9 weeks vs 39.4 weeks). They also had a significantly increased risk of poor developmental outcome at school entry (16.2% vs 12.7%; absolute difference, 3.5% [95% CI, 0.5%-6.5%]); adjusted odds ratio [aOR], 1.36 [95% CI, 1.07-1.74]) and poor educational outcomes in grades 3, 5, and 7 (for example, in grade 7: 13.4% vs 10.5%; absolute difference, 2.9% [95% CI, 0.4%-5.5%]); aOR, 1.33 [95% CI, 1.04-1.70]). There was no significant difference between infants with normal growth (birth weight ≥10th percentile) delivered for suspected FGR and those not suspected of having FGR in developmental outcome (8.6% vs 8.1%; absolute difference, 0.5% [95% CI, 1.1% to 2.0%]); aOR, 1.17 [95% CI, 0.95-1.45]) or educational outcome in grade 3, 5 or 7, despite being born earlier (mean gestation, 38.0 weeks vs 39.1 weeks).

Conclusions and Relevance  In this exploratory study conducted in Victoria, Australia, iatrogenic delivery of infants with severe SGA due to suspected FGR was associated with poorer school outcomes compared with infants with severe SGA not suspected of having FGR. Iatrogenic delivery of infants with normal growth due to suspected FGR was not associated with poorer school outcomes compared with infants with normal growth not suspected of having FGR.

DOI: 10.1001/jama.2021.8608

Source: https://jamanetwork.com/journals/jama/article-abstract/2781857