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Abstract：
BACKGROUND: This study aimed (i) to assess the potential effect of placental location on uterine artery (UtA) pulsatility index (PI) and offspring birthweight (BW), and (ii) to examine the potential association of unilaterally increased UtA PI with preeclampsia (PE) or low BW.
METHODS: This was an asynchronous cohort study of singleton pregnancies between 20+0 and 23+6 gestational weeks resulting in live birth, for whom the placental site (posterior, anterior, fundal, previa, right lateral, or left lateral) and bilateral UtA PI measurements were recorded. The effect of placental location on mean BW and UtA mean PI z-scores was assessed using t-test or ANOVA and post-hoc tests, as appropriate. The UtA PI measurements were then grouped into three categories (normal mean PI; unilaterally increased PI with normal mean; increased mean PI) and we calculated the odds ratios (ORs) of unilaterally increased or increased mean PI vs. normal mean PI for PE, BW <10th centile and BW <5th centile. The independent association of placental location, UtA PI category (normal mean, unilateral increase with normal mean, increased mean PI) and UtA PI z-score with PE, BW <10th centile and BW <5th centile was then assessed using logistic regression.
RESULTS: The analysis included 5506 pregnancies. A lateral placenta was associated with higher mean PI z-score (p = .0001) and lower BW (p = .003) than non-lateral placenta. Compared with normal mean UtA PI, a unilaterally increased PI with a normal mean was associated with increased risk for PE (OR 4.3, 95%CI 1.9-9.7), BW <10th centile (OR 1.7, 95%CI 1.3-2.4) and BW <5th centile (OR 1.8, 95%CI 1.1-2.9). Similarly, increased mean UtA PI was also associated with increased risk for PE, BW <10th and BW <5th centile (OR 9.1, 95%CI 4.8-17.3; OR 4.4, 95%CI 3.5-5.7; OR 7.0, 95%CI 5.1-9.6, respectively). When assessing the independent association of placental location and UtA PI with PE and low BW, only mean UtA PI remains a significant predictor.
CONCLUSIONS: A lateral placenta is associated with a higher mean UtA PI and lower BW. Unilaterally increased UtA PI still carries a greater risk of PE and low BW than bilaterally normal PI, however this effect appears to be eventually mediated through mean UtA PI z-score, which is relatively increased in these cases.
METHODS: This was an asynchronous cohort study of singleton pregnancies between 20+0 and 23+6 gestational weeks resulting in live birth, for whom the placental site (posterior, anterior, fundal, previa, right lateral, or left lateral) and bilateral UtA PI measurements were recorded. The effect of placental location on mean BW and UtA mean PI z-scores was assessed using t-test or ANOVA and post-hoc tests, as appropriate. The UtA PI measurements were then grouped into three categories (normal mean PI; unilaterally increased PI with normal mean; increased mean PI) and we calculated the odds ratios (ORs) of unilaterally increased or increased mean PI vs. normal mean PI for PE, BW <10th centile and BW <5th centile. The independent association of placental location, UtA PI category (normal mean, unilateral increase with normal mean, increased mean PI) and UtA PI z-score with PE, BW <10th centile and BW <5th centile was then assessed using logistic regression.
RESULTS: The analysis included 5506 pregnancies. A lateral placenta was associated with higher mean PI z-score (p = .0001) and lower BW (p = .003) than non-lateral placenta. Compared with normal mean UtA PI, a unilaterally increased PI with a normal mean was associated with increased risk for PE (OR 4.3, 95%CI 1.9-9.7), BW <10th centile (OR 1.7, 95%CI 1.3-2.4) and BW <5th centile (OR 1.8, 95%CI 1.1-2.9). Similarly, increased mean UtA PI was also associated with increased risk for PE, BW <10th and BW <5th centile (OR 9.1, 95%CI 4.8-17.3; OR 4.4, 95%CI 3.5-5.7; OR 7.0, 95%CI 5.1-9.6, respectively). When assessing the independent association of placental location and UtA PI with PE and low BW, only mean UtA PI remains a significant predictor.
CONCLUSIONS: A lateral placenta is associated with a higher mean UtA PI and lower BW. Unilaterally increased UtA PI still carries a greater risk of PE and low BW than bilaterally normal PI, however this effect appears to be eventually mediated through mean UtA PI z-score, which is relatively increased in these cases.
摘要：
背景：这项研究旨在（i）评估胎盘位置对子宫动脉（UtA）搏动指数（PI）和后代出生体重（BW）的潜在影响，和（ii）检查单方面增加的UtAPI与先兆子痫（PE）或低BW的潜在关联。
方法：这是一项异步队列研究，涉及20+0至23+6孕周之间的单胎妊娠，导致活产，胎盘部位(后部，前,Fundal,previa,右侧,或左侧）和双侧UtAPI测量值被记录。使用t检验或ANOVA和事后检验评估胎盘位置对平均BW和UtA平均PIz得分的影响，视情况而定。然后将UtAPI测量分为三类（正常平均PI；具有正常平均的单边增加PI；增加的平均PI），我们计算了单边增加或增加的平均PI与PE的正常平均PI，BW<10个百分位数并且BW<5个百分位数。胎盘位置的独立关联，UtAPI类别(正常意思,单侧增加与正常均值，平均PI)和UtAPIz分数随PE增加，然后使用逻辑回归评估BW<10个百分位数和BW<5个百分位数。
结果：分析包括5506例妊娠。与非外侧胎盘相比，外侧胎盘具有较高的平均PIz评分（p=0.0001）和较低的BW（p=0.003）。与正常平均UtAPI相比，平均正常的单侧PI增加与PE风险增加相关(OR4.3,95CI1.9-9.7),BW<10个百分位数(OR1.7,95CI1.3-2.4)和BW<5个百分位数(OR1.8,95CI1.1-2.9)。同样，平均UtAPI增加也与PE风险增加有关，BW<10分和BW<5分(分别为OR9.1,95CI4.8-17.3;OR4.4,95CI3.5-5.7;OR7.0,95CI5.1-9.6)。在评估胎盘位置和UtAPI与PE和低BW的独立关联时，只有平均UtAPI仍然是一个重要的预测因子。
结论：外侧胎盘与较高的平均UtAPI和较低的BW相关。与双边正常PI相比，单边增加的UtAPI仍具有更大的PE和低BW风险，然而，这种影响似乎最终是通过平均UtAPIz分数介导的，在这些情况下相对增加。
方法：这是一项异步队列研究，涉及20+0至23+6孕周之间的单胎妊娠，导致活产，胎盘部位(后部，前,Fundal,previa,右侧,或左侧）和双侧UtAPI测量值被记录。使用t检验或ANOVA和事后检验评估胎盘位置对平均BW和UtA平均PIz得分的影响，视情况而定。然后将UtAPI测量分为三类（正常平均PI；具有正常平均的单边增加PI；增加的平均PI），我们计算了单边增加或增加的平均PI与PE的正常平均PI，BW<10个百分位数并且BW<5个百分位数。胎盘位置的独立关联，UtAPI类别(正常意思,单侧增加与正常均值，平均PI)和UtAPIz分数随PE增加，然后使用逻辑回归评估BW<10个百分位数和BW<5个百分位数。
结果：分析包括5506例妊娠。与非外侧胎盘相比，外侧胎盘具有较高的平均PIz评分（p=0.0001）和较低的BW（p=0.003）。与正常平均UtAPI相比，平均正常的单侧PI增加与PE风险增加相关(OR4.3,95CI1.9-9.7),BW<10个百分位数(OR1.7,95CI1.3-2.4)和BW<5个百分位数(OR1.8,95CI1.1-2.9)。同样，平均UtAPI增加也与PE风险增加有关，BW<10分和BW<5分(分别为OR9.1,95CI4.8-17.3;OR4.4,95CI3.5-5.7;OR7.0,95CI5.1-9.6)。在评估胎盘位置和UtAPI与PE和低BW的独立关联时，只有平均UtAPI仍然是一个重要的预测因子。
结论：外侧胎盘与较高的平均UtAPI和较低的BW相关。与双边正常PI相比，单边增加的UtAPI仍具有更大的PE和低BW风险，然而，这种影响似乎最终是通过平均UtAPIz分数介导的，在这些情况下相对增加。
