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“INTERGROWTH21st vs customized fetal growth curves in the assessment of the neonatal nutritional status: a retrospective cohort study of gestational diabetes”
BMC Pregnancy and Childbirth ( IF 3.1 ) Pub Date : 2020-03-04 , DOI: 10.1186/s12884-020-2845-y
Juan Jesús Fernández-Alba , Estefanía Soto Pazos , Rocío Moreno Cortés , Ángel Vilar Sánchez , Carmen González Macías , María Castillo Lara , Luis Moreno Corral , José Antonio Sainz Bueno

Gestational diabetes mellitus is associated with increased incidence of adverse perinatal outcomes including newborns large for gestational age, macrosomia, preeclampsia, polyhydramnios, stillbirth, and neonatal morbidity. Thus, fetal growth should be monitored by ultrasound to assess for fetal overnutrition, and thereby, its clinical consequence, macrosomia. However, it is not clear which reference curve to use to define the limits of normality. Our aim is to determine which method, INTERGROWTH21st or customized curves, better identifies the nutritional status of newborns of diabetic mothers. This retrospective cohort study compared the risk of malnutrition in SGA newborns and the risk of overnutrition in LGA newborns using INTERGROWTH21st and customized birth weight references in gestational diabetes. The nutritional status of newborns was assessed using the ponderal index. Additionally, to determine the ability of both methods in the identification of neonatal malnutrition and overnutrition, we calculate sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios. Two hundred thirty-one pregnant women with GDM were included in the study. The rate of SGA indentified by INTERGROWTH21st was 4.7% vs 10.7% identified by the customized curves. The rate of LGA identified by INTERGROWTH21st was 25.6% vs 13.2% identified by the customized method. Newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH21st. (RR 4.24 vs 2.5). LGA newborns according to the customized method also showed a higher risk of overnutrition than those classified as LGA according to INTERGROWTH21st. (RR 5.26 vs 3.57). In addition, the positive predictive value of the customized method was superior to that of INTERGROWTH21st in the identification of malnutrition (32% vs 27.27%), severe malnutrition (22.73% vs 20%), overnutrition (51.61% vs 32.20%) and severe overnutrition (28.57% vs 14.89%). In pregnant women with DMG, the ability of customized fetal growth curves to identify newborns with alterations in nutritional status appears to exceed that of INTERGROWTH21st.

中文翻译:

“在新生儿营养状况评估中的INTERGROWTH21st与定制胎儿生长曲线:妊娠糖尿病回顾性队列研究”

妊娠糖尿病与围产期不良结局的发生率增加相关,包括大胎龄,大儿,先兆子痫,羊水过多,死产和新生儿发病率高的新生儿。因此,应该通过超声监测胎儿的生长,以评估胎儿的营养过剩,从而评估其临床后果,即巨大儿。但是,尚不清楚使用哪个参考曲线来定义正态性极限。我们的目标是确定哪种方法,INTERGROWTH21st或自定义曲线可以更好地确定糖尿病母亲新生儿的营养状况。这项回顾性队列研究使用INTERGROWTH21st和定制的出生体重参考对妊娠糖尿病中SGA新生儿营养不良的风险和LGA新生儿营养不良的风险进行了比较。新生儿的营养状况使用普氏指数进行评估。此外,为了确定两种方法在鉴定新生儿营养不良和营养过剩方面的能力,我们计算了敏感性,特异性,阳性预测值,阴性预测值和似然比。该研究包括了213名GDM孕妇。INTERGROWTH21st鉴定的SGA率为4.7%,而定制曲线鉴定的为10.7%。INTERGROWTH21st鉴定的LGA率为25.6%,而定制方法鉴定的为13.2%。通过定制方法鉴定为SGA的新生儿比经INTERGROWTH21st鉴定为SGA的营养不良风险更高。(RR 4.24 vs 2.5)。与根据INTERGROWTH21st分类为LGA的婴儿相比,按照定制方法进行的LGA婴儿的营养不良风险也更高。(RR 5.26和3.57)。此外,在营养不良(32%vs 27.27%),严重营养不良(22.73%vs 20%),营养过剩(51.61%vs 32.20%)和严重营养不良的识别中,定制方法的阳性预测值优于INTERGROWTH21st。营养过剩(28.57%对14.89%)。在DMG孕妇中,定制的胎儿生长曲线识别营养状况改变的新生儿的能力似乎超过了INTERGROWTH21st。严重营养不良(22.73%vs 20%),营养过度(51.61%vs 32.20%)和严重营养不良(28.57%vs 14.89%)。在DMG孕妇中,定制的胎儿生长曲线识别营养状况发生变化的新生儿的能力似乎超过了INTERGROWTH21st。严重营养不良(22.73%vs 20%),营养过度(51.61%vs 32.20%)和严重营养不良(28.57%vs 14.89%)。在DMG孕妇中,定制的胎儿生长曲线识别营养状况发生变化的新生儿的能力似乎超过了INTERGROWTH21st。
更新日期:2020-03-06
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