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Association between SGA and preterm delivery
404 SPO Abstracts
521
522
January 1995 Am J Obstet Gynecol
IS PRIOR CERVICAL CONIZATION A RISK FACTOR FOR PRETERM PREGNANCY COMPLICATIONS? S~ J...: Marder, J. F. Huddleston, W. L. Gravesx. Emory University, Grady Memorial Hospital, Atlanta, Georgia OBJECTIVE: We investigated the risk from prior conization for preterm premature rupture of membranes (PPROM), preterm birth, and low birth weight. STUDY DESIGN: During the years 1987 through 1993, 163 women who had previously undergone cervical conization at Grady Memorial Hospital delivered at >_20 weeks at this hospital. Three concurrent controls delivering at >20 weeks were randomly chosen for each case. Cases and controls were compared according to maternal ago, parity, race, gestational age, birth weight, and PPROM. With a power of 80%, any significant difference exceeding 10-12% should have been detectable among comparisons. RESULTS: No statistically significant difference (p <0.05) in mean pregnancy duration, birth weight, or occurrence of PPROM was found between cases and controls. There was no statistically significant difference in PPROM for any birth weight or gestational-age group between cases and controls, except for the least clinically important: the most advanced (33-37 week) gestationalage group. (p <0.05) CONCLUSIONS: Prior cervical conization was not demonstrated to be a risk factor for prematu rity, low birth weight, or PPROM.
523
PREDICTION OF SPONTANEOUS PREMATURITY BASED ON PRIOR OBSTETRIC OUTCOME. B Mercer. R Goldenberg, A Moawad, P Mels, J Iams, R Copper x, A Darx, E Them x, F Johnson x, D McNellis, and the NICHD MFMU Network, Berhesd~, MD. OBJECTIVE: To evaluate the predictive value of the earliest prior spontaneous preterm delivery (SPTD) at various gestadonal ages on current pregnancy outcomes. STUDY DESIGN: 1301 multiparas at 10 centers were prospectively evaluated at 24 weeks gestation. Prior pregnandes were &xled for the gestadonal age at earliest prior SPTD at 4 gestational age ranges (13-22, 23-27, 28-34 and 35-36 weeks). Current gestations were categorized as SPTDs at <28, <30, <32, <35, or <37 weeks. RESULTS: The incidences o f prematurity in the 1301 singleton gestations were 0.8% (SPTD28), 1.1% (STPD30), 1.8% (STPD32), 5.4% (SPTD35), and 11.8% (SPTD37). When compared with women having no prior SPTD, those with a prior SPTD carried a 2.5 fold increase in risk of SPTD in the current gestation (21.5 vs. 8.7%). The absence of a prior SPTD was protective in the current gestation (see Table). A spontaneous previable delivery (13-22 weeks) was not associated with SPTD in the current gestation. The inddonces of SlrI'D prior to 28,30,32,35 and 37 weeks based on earliest prior SPTD at various gestations are listed in the Table as are the relative risks (g.g.) for SPTD when compared, t patients with no prior SPTDs. Prior SPTD SPTD28 SPTD30 SPTD32 SPTD35 SPTD37 Wcdu % (R.R.) % (R.R.) % (IZR.) % (IZR.) % (R.R.) 13.22 0 1.3 (3.3) 1,3 (1.6) 6,6 (2.5) 11.8 (1.4) 23-27 7.0 04.5)* 7.0 (17.3)* 14.0(17.3)* ' 25,6 (9.7)* 32.6 0.7)* 28-34 3.2 (16.0)* 4.0 (10.0)* 5.7 (7.0)* 15.3 (5.8)* 23.4 (2.7)* 35-36 1.5 (7.3) 1.5 (3.6) 2.9 (3.6) 13,2 (5.0)* 22.1 (2.5)* None 0.2 0.4 0.8 2.6 ' 8.7 * P <0.001 compared with women with no prior SPTDs CONCLUSIONS: Prevlable SPTD (13-22 weeks) is not generally predictive of subsequent pregnancy outcome. Prior early SPTD is more predictive of SPTD overall and early preterm delivery in the current pregnancy.
524
PSYCHOSOCIAL STATUS AND PREGNANCY OUTCOME. R. Conver, ~ R. Goldeoberg, A. Das? N. Elder? G Norman? M Swain," NICHD MFMU Network, Bethesda, MD. OBJECTIVE: To determine ffpoor psyehosoolal (PS) status in prognanoy predicts spontaneous pretenn birth (SPB), fetal growth restrictinn (FGR), or low hirthw¢ight (LBW). STUDY DESIGN: We assessed anxiety, stress, serf esteem, mastery, depression and overall PS status at 25-29wks in 1990 gravidaa using a 28item scale. The rates ofSPB (GA <35wks), LBW (<25008) and FGR (Brenner) in women of poor (lowest quartile) vs good (upper three qua:~iles) PS scores were compared. Odds ratios (OR) and 95 % Confidence Limits (CL) from multivariate analyses are shown bolow. RESULTS: In univarlate analyses, stress was related to SPB (6% v 3%, p < .05) and LEW (14 % v 10%, p < .05). Mastery was related to SPB (6% v 4%, p < .05) but neither the total PS score nor any other subseales predicted SPB, FGR or LBW. ARer multivariate adjustment for PS status and demographic characteristics, Black race remained related to SPB, FGR and LBW (p<.05). SPB PS Total Anxiety Esteem Mastery Depress Stress
OR .99 .98 1.0 .96 .98 .87
CL .98-1.0 ,94-1.0 .97-1.1 .91-1.0 .95-1.0 .78-.97
FGR OR 1.0 .99 .98 1.0 1.0 1,0
CL .99-1.0 .96-1.0 .93-1.0 .96-1.1 .96-1.0 .92-1.1
LBW OR CL .99 .99-1.0 .98 .99-1.0 1.0 .97-1.0 .97 .94-1.0 .98 .96-1.0 .93 .87-1.0
CONCLUSION: Stress was associated with SPB even after adjusting for dem0graphio traits. Adjusting for PS status does not reduce the risk of SPB, FGR, or LBW in Black women.
ASSOCIATION BETWEEN SGA AND PRETERM DELIVERY J Oardusi x C Ray x M Mongnlli x, C Baldwin x. Perinatal Research and Monitoring Unit, Queen's Medical Centre, Nottingham NO7 2UH, UK. OBJECTIVE: To investigate the association between preterm delivery and smallness for gestational age (SGA), using fetal weight-for-gestation rather than birthwe/ght-fer-gestationas reference standard. DESIGN A N D M E T H O D : Currently, cross-sectinnal birth weight charts are used to assess a baby's weight. In the preterm period however the distribution of birth weight is heavily skewed as it reflects a pathological population. We have developed a method of calculating weight-for-gestation centiles from an ultrasound derived intra-uterlne fetal weight standard based on normal, term pregnancies. This was used to calculatefetalweight centilesof prematurely born babies. RESULTS: A sample of 40,957 routine ultrasound dated pregnancies in Nottingham and Derby, UK were anal~,sed. Of these, 2069 (5.5 %) had preterm deliveries (< 37 weeks gestation). According to the crosssectional birth weight standard for this population, 13 % of the preterm babies were SGA (<10th centile);in contrast, our fetal weight standard derived from intrauterine growth curves showed that 23 % of these deliveries were SGA; i.e. 43 % of SGA babies delivering in the preterm period are missed by conventional assessment. CONCLUSIONS: Our study supports the view that current methods to assess pretenn birth weight fail to recognise SGA, and hence possible growth retardation, in a large proportion of cases. Preterm labor may be causally linked with growth retardation. The possibility of 1UGR ought to be considered before tocolysis is attempted to retard what may be an adaptive response. Fetal rather than neonatal weight standards should ba applied to assess the birthweight of pretcnn babies.
521
522
January 1995 Am J Obstet Gynecol
IS PRIOR CERVICAL CONIZATION A RISK FACTOR FOR PRETERM PREGNANCY COMPLICATIONS? S~ J...: Marder, J. F. Huddleston, W. L. Gravesx. Emory University, Grady Memorial Hospital, Atlanta, Georgia OBJECTIVE: We investigated the risk from prior conization for preterm premature rupture of membranes (PPROM), preterm birth, and low birth weight. STUDY DESIGN: During the years 1987 through 1993, 163 women who had previously undergone cervical conization at Grady Memorial Hospital delivered at >_20 weeks at this hospital. Three concurrent controls delivering at >20 weeks were randomly chosen for each case. Cases and controls were compared according to maternal ago, parity, race, gestational age, birth weight, and PPROM. With a power of 80%, any significant difference exceeding 10-12% should have been detectable among comparisons. RESULTS: No statistically significant difference (p <0.05) in mean pregnancy duration, birth weight, or occurrence of PPROM was found between cases and controls. There was no statistically significant difference in PPROM for any birth weight or gestational-age group between cases and controls, except for the least clinically important: the most advanced (33-37 week) gestationalage group. (p <0.05) CONCLUSIONS: Prior cervical conization was not demonstrated to be a risk factor for prematu rity, low birth weight, or PPROM.
523
PREDICTION OF SPONTANEOUS PREMATURITY BASED ON PRIOR OBSTETRIC OUTCOME. B Mercer. R Goldenberg, A Moawad, P Mels, J Iams, R Copper x, A Darx, E Them x, F Johnson x, D McNellis, and the NICHD MFMU Network, Berhesd~, MD. OBJECTIVE: To evaluate the predictive value of the earliest prior spontaneous preterm delivery (SPTD) at various gestadonal ages on current pregnancy outcomes. STUDY DESIGN: 1301 multiparas at 10 centers were prospectively evaluated at 24 weeks gestation. Prior pregnandes were &xled for the gestadonal age at earliest prior SPTD at 4 gestational age ranges (13-22, 23-27, 28-34 and 35-36 weeks). Current gestations were categorized as SPTDs at <28, <30, <32, <35, or <37 weeks. RESULTS: The incidences o f prematurity in the 1301 singleton gestations were 0.8% (SPTD28), 1.1% (STPD30), 1.8% (STPD32), 5.4% (SPTD35), and 11.8% (SPTD37). When compared with women having no prior SPTD, those with a prior SPTD carried a 2.5 fold increase in risk of SPTD in the current gestation (21.5 vs. 8.7%). The absence of a prior SPTD was protective in the current gestation (see Table). A spontaneous previable delivery (13-22 weeks) was not associated with SPTD in the current gestation. The inddonces of SlrI'D prior to 28,30,32,35 and 37 weeks based on earliest prior SPTD at various gestations are listed in the Table as are the relative risks (g.g.) for SPTD when compared, t patients with no prior SPTDs. Prior SPTD SPTD28 SPTD30 SPTD32 SPTD35 SPTD37 Wcdu % (R.R.) % (R.R.) % (IZR.) % (IZR.) % (R.R.) 13.22 0 1.3 (3.3) 1,3 (1.6) 6,6 (2.5) 11.8 (1.4) 23-27 7.0 04.5)* 7.0 (17.3)* 14.0(17.3)* ' 25,6 (9.7)* 32.6 0.7)* 28-34 3.2 (16.0)* 4.0 (10.0)* 5.7 (7.0)* 15.3 (5.8)* 23.4 (2.7)* 35-36 1.5 (7.3) 1.5 (3.6) 2.9 (3.6) 13,2 (5.0)* 22.1 (2.5)* None 0.2 0.4 0.8 2.6 ' 8.7 * P <0.001 compared with women with no prior SPTDs CONCLUSIONS: Prevlable SPTD (13-22 weeks) is not generally predictive of subsequent pregnancy outcome. Prior early SPTD is more predictive of SPTD overall and early preterm delivery in the current pregnancy.
524
PSYCHOSOCIAL STATUS AND PREGNANCY OUTCOME. R. Conver, ~ R. Goldeoberg, A. Das? N. Elder? G Norman? M Swain," NICHD MFMU Network, Bethesda, MD. OBJECTIVE: To determine ffpoor psyehosoolal (PS) status in prognanoy predicts spontaneous pretenn birth (SPB), fetal growth restrictinn (FGR), or low hirthw¢ight (LBW). STUDY DESIGN: We assessed anxiety, stress, serf esteem, mastery, depression and overall PS status at 25-29wks in 1990 gravidaa using a 28item scale. The rates ofSPB (GA <35wks), LBW (<25008) and FGR (Brenner) in women of poor (lowest quartile) vs good (upper three qua:~iles) PS scores were compared. Odds ratios (OR) and 95 % Confidence Limits (CL) from multivariate analyses are shown bolow. RESULTS: In univarlate analyses, stress was related to SPB (6% v 3%, p < .05) and LEW (14 % v 10%, p < .05). Mastery was related to SPB (6% v 4%, p < .05) but neither the total PS score nor any other subseales predicted SPB, FGR or LBW. ARer multivariate adjustment for PS status and demographic characteristics, Black race remained related to SPB, FGR and LBW (p<.05). SPB PS Total Anxiety Esteem Mastery Depress Stress
OR .99 .98 1.0 .96 .98 .87
CL .98-1.0 ,94-1.0 .97-1.1 .91-1.0 .95-1.0 .78-.97
FGR OR 1.0 .99 .98 1.0 1.0 1,0
CL .99-1.0 .96-1.0 .93-1.0 .96-1.1 .96-1.0 .92-1.1
LBW OR CL .99 .99-1.0 .98 .99-1.0 1.0 .97-1.0 .97 .94-1.0 .98 .96-1.0 .93 .87-1.0
CONCLUSION: Stress was associated with SPB even after adjusting for dem0graphio traits. Adjusting for PS status does not reduce the risk of SPB, FGR, or LBW in Black women.
ASSOCIATION BETWEEN SGA AND PRETERM DELIVERY J Oardusi x C Ray x M Mongnlli x, C Baldwin x. Perinatal Research and Monitoring Unit, Queen's Medical Centre, Nottingham NO7 2UH, UK. OBJECTIVE: To investigate the association between preterm delivery and smallness for gestational age (SGA), using fetal weight-for-gestation rather than birthwe/ght-fer-gestationas reference standard. DESIGN A N D M E T H O D : Currently, cross-sectinnal birth weight charts are used to assess a baby's weight. In the preterm period however the distribution of birth weight is heavily skewed as it reflects a pathological population. We have developed a method of calculating weight-for-gestation centiles from an ultrasound derived intra-uterlne fetal weight standard based on normal, term pregnancies. This was used to calculatefetalweight centilesof prematurely born babies. RESULTS: A sample of 40,957 routine ultrasound dated pregnancies in Nottingham and Derby, UK were anal~,sed. Of these, 2069 (5.5 %) had preterm deliveries (< 37 weeks gestation). According to the crosssectional birth weight standard for this population, 13 % of the preterm babies were SGA (<10th centile);in contrast, our fetal weight standard derived from intrauterine growth curves showed that 23 % of these deliveries were SGA; i.e. 43 % of SGA babies delivering in the preterm period are missed by conventional assessment. CONCLUSIONS: Our study supports the view that current methods to assess pretenn birth weight fail to recognise SGA, and hence possible growth retardation, in a large proportion of cases. Preterm labor may be causally linked with growth retardation. The possibility of 1UGR ought to be considered before tocolysis is attempted to retard what may be an adaptive response. Fetal rather than neonatal weight standards should ba applied to assess the birthweight of pretcnn babies.