Clinical Characteristics and Risk Factors of Preeclampsia with Fetal Growth Restriction as the First Symptom
Objective To investigate the clinical characteristics and pregnancy outcome of preeclampsia with fetal growth restriction(FGR)as the first symptom,and to provide reference for prenatal consultation and management.Methods A total of 120 patients with FGR admitted to the Obstetrics Department of the First Affiliated Hospital of Zhengzhou University From January 2018 to January 2023 were selected as the research objects,among which 40 patients with preeclampsia were taken as the study group,and 80 patients without preeclampsia were taken as the control group.The general characteristics,complications during pregnancy,maternal and perinatal outcomes and other data of the two groups were analyzed retrospectively.Logistic regression was used to analyze the risk factors of FGR complicated with preeclampsia,and the area under the ROC curve was calculated to analyze the efficacy of risk factors in predicting preeclampsia.Results(1)General characteristics:There were statistically significant differences between the study group and the control group in pre-pregnancy body mass index and gestational age at diagnosis of FGR(P＜0.05).There were no significant differences in age,proportion of primipara,irregular birth examination,assisted reproduction and adverse pregnancy history between the two groups(P＞0.05).(2)Complications during pregnancy:There were significant differences in the proportion of proteinuria and positive antiphospholipid antibody between the study group and the control group(P＜0.05).There were no significant differences in hyperglycemia,hypothyroidism,umbilical cord torsion,uterine malformation,hypomniotic fluid and anemia between the two groups(P＞0.05).(3)Maternal pregnancy outcome:the pregnancy complications,cesarean section rate and hospitalization days in the study group were significantly higher than those in the control group(P＜0.05).(4)Neonatal outcome:There were 6 cases of medical induced labor in the study group and 4 cases in the control group.There were statistically significant differences in the rate of premature delivery,gestational weeks at delivery and newborn weight between the two groups(P＜0.05).There were significant differences in neonatal ventricular hemorrhage,neonatal asphyxia,respiratory distress syndrome and metabolic acidosis between the study group and the control group(P＜0.05),but there was no statistically significant difference in perinatal mortality between the two groups(P＞0.05).(5)Logistic regression analysis showed that gestational age at diagnosis of FGR and pre-pregnancy body mass index were risk factors for preeclampsia with FGR as the first symptom.ROC curve analysis showed that gestational age at diagnosis of FGR(AUC=0.817,95％CI 0.723-0.911)and pre-pregnancy body mass index(AUC=0.714,95％CI 0.621-0.807)could be used to predict the risk of preeclampsia,and the combined prediction(AUC=0.860,95％CI 0.785-0.934)was superior to the single index.Conclusion FGR complicated with preeclampsia can increase maternal and fetal adverse pregnancy outcomes.Gestational age and pre-pregnancy body mass index at the time of diagnosis of FGR are independent risk factors for preeclampsia.Strengthening the monitoring and treatment of early warning factors is helpful for early identification of preeclampsia and improvement of maternal and fetal prognosis.
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