Abstract：
Fetal growth restriction is an independent risk factor for fetal death and adverse neonatal outcomes. The main aim of this study was to investigate the diagnostic performance of 32 vs 36 weeks ultrasound of fetal biometry in detecting late-onset fetal growth restriction and predicting small-for-gestational-age neonates.
A systematic search was performed to identify relevant studies published until June 2022, using the databases PubMed, Web of Science, and Scopus.
Cohort studies in low-risk or unselected singleton pregnancies with screening ultrasound performed at ≥32 weeks of gestation were used.
The estimated fetal weight and abdominal circumference were assessed as index tests for the prediction of small for gestational age (birthweight of <10th percentile) and detecting fetal growth restriction (estimated fetal weight of <10th percentile and/or abdominal circumference of <10th percentile). The quality of the included studies was independently assessed by 2 reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. For the meta-analysis, hierarchical summary area under the receiver operating characteristic curves were constructed, and quantitative data synthesis was performed using random-effects models.
The analysis included 25 studies encompassing 73,981 low-risk pregnancies undergoing third-trimester ultrasound assessment for growth, of which 5380 neonates (7.3%) were small for gestational age at birth. The pooled sensitivities for estimated fetal weight of <10th percentile and abdominal circumference of <10th percentile in predicting small for gestational age were 36% (95% confidence interval, 27%-46%) and 37% (95% confidence interval, 19%-60%), respectively, at 32 weeks ultrasound and 48% (95% confidence interval, 41%-56%) and 50% (95% confidence interval, 25%-74%), respectively, at 36 weeks ultrasound. The pooled specificities for estimated fetal weight of <10th percentile and abdominal circumference of <10th percentile in detecting small for gestational age were 93% (95% confidence interval, 91%-95%) and 95% (95% confidence interval, 85%-98%), respectively, at 32 weeks ultrasound and 93% (95% confidence interval, 91%-95%) and 97% (95% confidence interval, 85%-98%), respectively, at 36 weeks ultrasound. The observed diagnostic odds ratios for an estimated fetal weight of <10th percentile and an abdominal circumference of <10th percentile in detecting small for gestational age were 8.8 (95% confidence interval, 5.4-14.4) and 11.6 (95% confidence interval, 6.2-21.6), respectively, at 32 weeks ultrasound and 13.3 (95% confidence interval, 10.4-16.9) and 36.0 (95% confidence interval, 4.9-260.0), respectively, at 36 weeks ultrasound. The pooled sensitivity, specificity, and diagnostic odds ratio in predicting fetal growth restriction were 71% (95% confidence interval, 52%-85%), 90% (95% confidence interval, 79%-95%), and 25.8 (95% confidence interval, 14.5-45.8), respectively, at 32 weeks ultrasound and 48% (95% confidence interval, 41%-55%), 94% (95% confidence interval, 93%-96%), and 16.9 (95% confidence interval, 10.8-26.6), respectively, at 36 weeks ultrasound. Abdominal circumference of <10th percentile seemed to have comparable sensitivity to estimated fetal weight of <10th percentile in predicting small-for-gestational-age neonates.
An ultrasound assessment of the fetal biometry at 36 weeks of gestation seemed to have better predictive accuracy for small-for-gestational-age neonates than an ultrasound assessment at 32 weeks of gestation. However, an opposite trend was noted when the outcome was fetal growth restriction. Fetal abdominal circumference had a similar predictive accuracy to that of estimated fetal weight in detecting small-for-gestational-age neonates.
A systematic search was performed to identify relevant studies published until June 2022, using the databases PubMed, Web of Science, and Scopus.
Cohort studies in low-risk or unselected singleton pregnancies with screening ultrasound performed at ≥32 weeks of gestation were used.
The estimated fetal weight and abdominal circumference were assessed as index tests for the prediction of small for gestational age (birthweight of <10th percentile) and detecting fetal growth restriction (estimated fetal weight of <10th percentile and/or abdominal circumference of <10th percentile). The quality of the included studies was independently assessed by 2 reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. For the meta-analysis, hierarchical summary area under the receiver operating characteristic curves were constructed, and quantitative data synthesis was performed using random-effects models.
The analysis included 25 studies encompassing 73,981 low-risk pregnancies undergoing third-trimester ultrasound assessment for growth, of which 5380 neonates (7.3%) were small for gestational age at birth. The pooled sensitivities for estimated fetal weight of <10th percentile and abdominal circumference of <10th percentile in predicting small for gestational age were 36% (95% confidence interval, 27%-46%) and 37% (95% confidence interval, 19%-60%), respectively, at 32 weeks ultrasound and 48% (95% confidence interval, 41%-56%) and 50% (95% confidence interval, 25%-74%), respectively, at 36 weeks ultrasound. The pooled specificities for estimated fetal weight of <10th percentile and abdominal circumference of <10th percentile in detecting small for gestational age were 93% (95% confidence interval, 91%-95%) and 95% (95% confidence interval, 85%-98%), respectively, at 32 weeks ultrasound and 93% (95% confidence interval, 91%-95%) and 97% (95% confidence interval, 85%-98%), respectively, at 36 weeks ultrasound. The observed diagnostic odds ratios for an estimated fetal weight of <10th percentile and an abdominal circumference of <10th percentile in detecting small for gestational age were 8.8 (95% confidence interval, 5.4-14.4) and 11.6 (95% confidence interval, 6.2-21.6), respectively, at 32 weeks ultrasound and 13.3 (95% confidence interval, 10.4-16.9) and 36.0 (95% confidence interval, 4.9-260.0), respectively, at 36 weeks ultrasound. The pooled sensitivity, specificity, and diagnostic odds ratio in predicting fetal growth restriction were 71% (95% confidence interval, 52%-85%), 90% (95% confidence interval, 79%-95%), and 25.8 (95% confidence interval, 14.5-45.8), respectively, at 32 weeks ultrasound and 48% (95% confidence interval, 41%-55%), 94% (95% confidence interval, 93%-96%), and 16.9 (95% confidence interval, 10.8-26.6), respectively, at 36 weeks ultrasound. Abdominal circumference of <10th percentile seemed to have comparable sensitivity to estimated fetal weight of <10th percentile in predicting small-for-gestational-age neonates.
An ultrasound assessment of the fetal biometry at 36 weeks of gestation seemed to have better predictive accuracy for small-for-gestational-age neonates than an ultrasound assessment at 32 weeks of gestation. However, an opposite trend was noted when the outcome was fetal growth restriction. Fetal abdominal circumference had a similar predictive accuracy to that of estimated fetal weight in detecting small-for-gestational-age neonates.
摘要：
目的：胎儿生长受限是胎儿死亡和不良新生儿结局的独立危险因素。这项研究的主要目的是研究32与36周胎儿生物测量超声在检测迟发性胎儿生长受限和预测小于胎龄儿中的诊断性能。
方法：使用数据库PubMed进行了系统搜索，以确定直到2022年6月发表的相关研究，WebofScience,还有Scopus.
方法：对低风险或未选择的单胎妊娠进行队列研究，并在妊娠≥32周时进行超声筛查。
方法：评估胎儿体重和腹围作为预测胎龄小（出生体重<10百分位数）和检测胎儿生长受限（估计胎儿体重<10百分位数和/或腹围<10百分位数）的指标测试。纳入研究的质量由2名评审员使用诊断准确性研究2的质量评估工具进行独立评估。对于荟萃分析，构建了接收器工作特性曲线下的分层汇总区域，并使用随机效应模型进行定量数据合成。
结果：该分析包括25项研究，包括73,981例低风险妊娠，进行妊娠晚期超声评估，其中5380名新生儿(7.3%)出生时小于胎龄。在预测小于胎龄时，估计胎儿体重<10百分位数和腹围<10百分位数的合并敏感性为36％（95％置信区间，27%-46%)和37%(95%置信区间，19%-60%），分别,在32周超声和48%(95%置信区间，41%-56%)和50%(95%置信区间，25%-74%），分别,在36周超声检查。在检测小于胎龄时，估计胎儿体重<10百分位数和腹围<10百分位数的合并特异性为93％（95％置信区间，91%-95%)和95%(95%置信区间，85%-98%），分别,在32周超声和93%(95%置信区间，91%-95%)和97%(95%置信区间，85%-98%），分别,在36周超声检查。在检测小于胎龄时，估计胎儿体重<10百分位数和腹围<10百分位数的诊断优势比为8.8（95％置信区间，5.4-14.4)和11.6(95%置信区间，6.2-21.6),分别,在32周超声和13.3(95%置信区间，10.4-16.9)和36.0(95%置信区间，4.9-260.0),分别,在36周超声检查。汇集的敏感性，特异性，预测胎儿生长受限的诊断比值比为71%(95%置信区间，52%-85%），90%(95%置信区间，79%-95%)，和25.8(95%置信区间，14.5-45.8)，分别,在32周超声和48%(95%置信区间，41%-55%），94%(95%置信区间，93%-96%），和16.9(95%置信区间，10.8-26.6),分别,在36周超声检查。在预测小于胎龄新生儿时，<10百分位数的腹围似乎与<10百分位数的估计胎儿体重具有相当的敏感性。
结论：对于小于胎龄新生儿，妊娠36周时的超声评估似乎比妊娠32周时的超声评估具有更好的预测准确性。然而,当结局是胎儿生长受限时,观察到相反的趋势.在检测小于胎龄新生儿时，胎儿腹围的预测准确性与估计的胎儿体重相似。
方法：使用数据库PubMed进行了系统搜索，以确定直到2022年6月发表的相关研究，WebofScience,还有Scopus.
方法：对低风险或未选择的单胎妊娠进行队列研究，并在妊娠≥32周时进行超声筛查。
方法：评估胎儿体重和腹围作为预测胎龄小（出生体重<10百分位数）和检测胎儿生长受限（估计胎儿体重<10百分位数和/或腹围<10百分位数）的指标测试。纳入研究的质量由2名评审员使用诊断准确性研究2的质量评估工具进行独立评估。对于荟萃分析，构建了接收器工作特性曲线下的分层汇总区域，并使用随机效应模型进行定量数据合成。
结果：该分析包括25项研究，包括73,981例低风险妊娠，进行妊娠晚期超声评估，其中5380名新生儿(7.3%)出生时小于胎龄。在预测小于胎龄时，估计胎儿体重<10百分位数和腹围<10百分位数的合并敏感性为36％（95％置信区间，27%-46%)和37%(95%置信区间，19%-60%），分别,在32周超声和48%(95%置信区间，41%-56%)和50%(95%置信区间，25%-74%），分别,在36周超声检查。在检测小于胎龄时，估计胎儿体重<10百分位数和腹围<10百分位数的合并特异性为93％（95％置信区间，91%-95%)和95%(95%置信区间，85%-98%），分别,在32周超声和93%(95%置信区间，91%-95%)和97%(95%置信区间，85%-98%），分别,在36周超声检查。在检测小于胎龄时，估计胎儿体重<10百分位数和腹围<10百分位数的诊断优势比为8.8（95％置信区间，5.4-14.4)和11.6(95%置信区间，6.2-21.6),分别,在32周超声和13.3(95%置信区间，10.4-16.9)和36.0(95%置信区间，4.9-260.0),分别,在36周超声检查。汇集的敏感性，特异性，预测胎儿生长受限的诊断比值比为71%(95%置信区间，52%-85%），90%(95%置信区间，79%-95%)，和25.8(95%置信区间，14.5-45.8)，分别,在32周超声和48%(95%置信区间，41%-55%），94%(95%置信区间，93%-96%），和16.9(95%置信区间，10.8-26.6),分别,在36周超声检查。在预测小于胎龄新生儿时，<10百分位数的腹围似乎与<10百分位数的估计胎儿体重具有相当的敏感性。
结论：对于小于胎龄新生儿，妊娠36周时的超声评估似乎比妊娠32周时的超声评估具有更好的预测准确性。然而,当结局是胎儿生长受限时,观察到相反的趋势.在检测小于胎龄新生儿时，胎儿腹围的预测准确性与估计的胎儿体重相似。
