Faktori udruženi sa feto-embrionalnim zastojem u rastu ploda

Abstract

Uvod: Uprkos razvoju ultrazvučnih metoda koje se mogu koristiti za rano otkrivanje zastoja u rastu ploda (Fetal Growth Restriction- FGR), intrauterini FGR ostaje neprepoznat do rođenja u većini slučajeva. Cilj ovog istraživanja je bio da se identifikuju faktori rizika koji doprinose pojavi FGR-a u trudnoći i rađanju novorođenčadi koja su mala za gestacijsku starost (Small for Gestational Age- SGA). Materijal i metod: Istraživanje je dizajnirano kao bidirekcionalna kohortna studija koja je sprovedena na populaciji trudnica koje su praćene i kontrolisane u okviru Klinike za ginekologiju i akušerstvo Univerzitetskog kliničkog centra Kragujevac. Stepen intrauterusnog razvoja ploda je procenjivan izračunavanjem procenjene telesne težine fetusa (Estimated Fetal Weight- EFW) pomoću ultrazvučno izmerenih anatomskih parametara rasta fetusa. Fetusi čija EFW se nalazila ispod 10-og centila na grafikonu rasta prilagođenom za pol i gestacijsku starost bili su označeni kao FGR, dok su novorođenčad čija je telesna težina na rođenju bila ispod 10-og centila smatrana za SGA. Rezultati: Faktori rizika za pojavu FGR-a ili SGA bili su manja telesna visina majke (FGR u drugom i trećem trimestru i SGA), manja životna starost majke (FGR u drugom trimestru), pušenje u toku trudnoće (FGR u trećem trimestru i SGA), proteinurija u trudnoći (FGR u drugom i trećem trimestru i SGA) i upotreba kortikosteroida u trudnoći (SGA), dok je suplementacija gvožđem imala protektivno dejstvo na pojavu FGR-a u trećem trimestru trudnoće. Zaključak: Identifikovani faktori rizika mogu biti implementirani u kliničku praksu kao važan dopunski element skrininga za pojavu zastoja u rastu ploda u trudnoći.

Introduction: Despite the development of ultrasound methods that can be used for early detection of fetal growth restriction (FGR), intrauterine FGR remains unrecognized until birth in most cases. The aim of this research was to identify risk factors that contribute to the occurrence of FGR during pregnancy and the birth of infants who are small for gestational age (SGA). Material and methods: The research was designed as a bidirectional cohort study that was conducted on the population of pregnant women who were monitored and controlled within the Clinic for Gynecology and Obstetrics of the University Clinical Center Kragujevac. The degree of intrauterine fetal development was assessed by calculating the estimated fetal body weight (EFW) using ultrasound-measured anatomical parameters of fetal growth. Fetuses whose EFW was below the 10th percentile on thе fetal growth chart adjusted for gender and gestational age were classified as FGR fetuses, while newborns weighing less than the 10th percentile were considered SGA. Results: Significant risk factors associated with FGR or SGA in our study were lower maternal body height (FGR during the second and third trimesters and SGA), younger maternal age (FGR during the second trimester), smoking during pregnancy (FGR during the third trimester and SGA), proteinuria in pregnancy (FGR during the second and third trimesters and SGA) and use of corticosteroids in pregnancy (SGA), while iron supplementation was a protective factor for the occurrence of FGR during the third trimester of pregnancy. Conclusion: Identified risk factors can be implemented in clinical practice as an important additional element of screening for FGR during pregnancy.