Abstract：
OBJECTIVE: To investigate the effect of low-molecular-weight heparin (LMWH) on placenta-mediated fetal growth restriction (FGR).
METHODS: A cohort of 570 pregnant women diagnosed with placenta-mediated FGR were enrolled from January 1, 2015 through to December 31, 2021. A birth database, including demographic data, antenatal complications, and detailed delivery and newborn data, was created to collect variables from the Hospital Information System (HIS) Database. The unique personal registration number, assigned to each patient on first registration with HIS in the West China Second University Hospital, was used to link these patients. LMWH use was defined as at least 1-week prescription from diagnosis of placenta-mediated FGR. Pregnant women received LMWH (Enoxaparin 4000 IU/day) by self-administered subcutaneous injection only when they agreed and signed informed consent. Primary outcome was intrauterine fetal death after 20 weeks of pregnancy. Secondary outcomes included preterm birth (PB), Apgar score less than 7 at 1 min, admission to neonatal intensive care unit (NICU), and birth weight. Logistic regression analysis was conducted to compute adjusted odds ratio (aOR) with 95% confidence intervals (CI) for outcomes.
RESULTS: After controlling for confounders, LMWH use was associated with a decreased risk of intrauterine fetal death (aOR 2.49, 95% CI 1.35-4.57, P = 0.003), PB before 37 weeks of pregnancy (aOR 3.35, 95% CI 2.14-5.23, P < 0.001), PB before 34 weeks of pregnancy (aOR 2.25, 95% CI 1.36-3.74, P = 0.002), Apgar score less than 7 at 1 min (aOR 2.25, 95% CI 1.36-3.74, P = 0.002), NICU admission (aOR 2.29, 95% CI 1.48-3.55, P < 0.001). Using LMWH increased the mean birth weight in PB before 32 weeks of pregnancy (mean ± standard deviation [SD] 1126.4 ± 520.0 g, P = 0.020), PB before 37 weeks of pregnancy (mean ± SD 1563.9 ± 502.7 g, P = 0.019), early-onset FGR (mean ± SD 2125.2 ± 665.7 g, P < 0.001), late-onset FGR (mean ± SD 2343.4 ± 507.9, P < 0.001), and non-severe FGR (mean ± SD 2231.1 ± 607.2 g, P < 0.001).
CONCLUSIONS: Use of LMWH can significantly improve the fetal and neonatal outcomes among pregnant women with placenta-mediated FGR, particularly reducing the risk of intrauterine fetal death.
METHODS: A cohort of 570 pregnant women diagnosed with placenta-mediated FGR were enrolled from January 1, 2015 through to December 31, 2021. A birth database, including demographic data, antenatal complications, and detailed delivery and newborn data, was created to collect variables from the Hospital Information System (HIS) Database. The unique personal registration number, assigned to each patient on first registration with HIS in the West China Second University Hospital, was used to link these patients. LMWH use was defined as at least 1-week prescription from diagnosis of placenta-mediated FGR. Pregnant women received LMWH (Enoxaparin 4000 IU/day) by self-administered subcutaneous injection only when they agreed and signed informed consent. Primary outcome was intrauterine fetal death after 20 weeks of pregnancy. Secondary outcomes included preterm birth (PB), Apgar score less than 7 at 1 min, admission to neonatal intensive care unit (NICU), and birth weight. Logistic regression analysis was conducted to compute adjusted odds ratio (aOR) with 95% confidence intervals (CI) for outcomes.
RESULTS: After controlling for confounders, LMWH use was associated with a decreased risk of intrauterine fetal death (aOR 2.49, 95% CI 1.35-4.57, P = 0.003), PB before 37 weeks of pregnancy (aOR 3.35, 95% CI 2.14-5.23, P < 0.001), PB before 34 weeks of pregnancy (aOR 2.25, 95% CI 1.36-3.74, P = 0.002), Apgar score less than 7 at 1 min (aOR 2.25, 95% CI 1.36-3.74, P = 0.002), NICU admission (aOR 2.29, 95% CI 1.48-3.55, P < 0.001). Using LMWH increased the mean birth weight in PB before 32 weeks of pregnancy (mean ± standard deviation [SD] 1126.4 ± 520.0 g, P = 0.020), PB before 37 weeks of pregnancy (mean ± SD 1563.9 ± 502.7 g, P = 0.019), early-onset FGR (mean ± SD 2125.2 ± 665.7 g, P < 0.001), late-onset FGR (mean ± SD 2343.4 ± 507.9, P < 0.001), and non-severe FGR (mean ± SD 2231.1 ± 607.2 g, P < 0.001).
CONCLUSIONS: Use of LMWH can significantly improve the fetal and neonatal outcomes among pregnant women with placenta-mediated FGR, particularly reducing the risk of intrauterine fetal death.
摘要：
目的：探讨低分子肝素（LMWH）对胎盘介导的胎儿生长受限（FGR）的影响。
方法：从2015年1月1日至2021年12月31日，纳入570名被诊断为胎盘介导的FGR的孕妇。一个出生数据库，包括人口统计数据，产前并发症,以及详细的分娩和新生儿数据，是为了从医院信息系统(HIS)数据库收集变量而创建的。唯一的个人登记号，在华西第二大学医院首次注册时分配给每位患者，被用来联系这些病人。LMWH的使用定义为从胎盘介导的FGR诊断开始至少1周的处方。只有当孕妇同意并签署知情同意书时，才会通过自我皮下注射接受LMWH（依诺肝素4000IU/天）。主要结局是妊娠20周后宫内胎儿死亡。次要结局包括早产（PB），1分钟时Apgar得分小于7，入院新生儿重症监护病房（NICU），出生体重。进行Logistic回归分析以计算结果的校正比值比（aOR）和95％置信区间（CI）。
结果：控制混杂因素后，使用LMWH与宫内胎儿死亡风险降低相关(aOR2.49,95%CI1.35-4.57,P=0.003),妊娠37周前的PB（aOR3.35，95％CI2.14-5.23，P<0.001），妊娠34周前的PB（aOR2.25，95％CI1.36-3.74，P=0.002），1分钟时Apgar评分小于7（aOR2.25，95％CI1.36-3.74，P=0.002），NICU入院（aOR2.29，95%CI1.48-3.55，P<0.001）。使用LMWH增加了妊娠32周前PB的平均出生体重（平均值±标准偏差[SD]1126.4±520.0g，P=0.020),怀孕37周前的PB（平均值±SD1563.9±502.7g，P=0.019),早发性FGR（平均值±SD2125.2±665.7g，P<0.001)，晚发性FGR（平均值±SD2343.4±507.9，P<0.001），和非重度FGR（平均值±SD2231.1±607.2g，P<0.001)。
结论：使用LMWH可显著改善胎盘介导的FGR孕妇的胎儿和新生儿结局。特别是降低宫内胎儿死亡的风险。
方法：从2015年1月1日至2021年12月31日，纳入570名被诊断为胎盘介导的FGR的孕妇。一个出生数据库，包括人口统计数据，产前并发症,以及详细的分娩和新生儿数据，是为了从医院信息系统(HIS)数据库收集变量而创建的。唯一的个人登记号，在华西第二大学医院首次注册时分配给每位患者，被用来联系这些病人。LMWH的使用定义为从胎盘介导的FGR诊断开始至少1周的处方。只有当孕妇同意并签署知情同意书时，才会通过自我皮下注射接受LMWH（依诺肝素4000IU/天）。主要结局是妊娠20周后宫内胎儿死亡。次要结局包括早产（PB），1分钟时Apgar得分小于7，入院新生儿重症监护病房（NICU），出生体重。进行Logistic回归分析以计算结果的校正比值比（aOR）和95％置信区间（CI）。
结果：控制混杂因素后，使用LMWH与宫内胎儿死亡风险降低相关(aOR2.49,95%CI1.35-4.57,P=0.003),妊娠37周前的PB（aOR3.35，95％CI2.14-5.23，P<0.001），妊娠34周前的PB（aOR2.25，95％CI1.36-3.74，P=0.002），1分钟时Apgar评分小于7（aOR2.25，95％CI1.36-3.74，P=0.002），NICU入院（aOR2.29，95%CI1.48-3.55，P<0.001）。使用LMWH增加了妊娠32周前PB的平均出生体重（平均值±标准偏差[SD]1126.4±520.0g，P=0.020),怀孕37周前的PB（平均值±SD1563.9±502.7g，P=0.019),早发性FGR（平均值±SD2125.2±665.7g，P<0.001)，晚发性FGR（平均值±SD2343.4±507.9，P<0.001），和非重度FGR（平均值±SD2231.1±607.2g，P<0.001)。
结论：使用LMWH可显著改善胎盘介导的FGR孕妇的胎儿和新生儿结局。特别是降低宫内胎儿死亡的风险。
