Clinical characteristics and perinatal outcomes of preeclampsia with single first fetal growth restriction
Objective To investigate the clinical characteristics and perinatal outcomes of preeclampsia(PE)with sin-gle first fetal growth restriction(FGR).Methods A total of 4091 PE patients were selected,who received examinations and delivered from January 2012 to December 2022 in Fujian Maternal and Child Health Hospital according to the inclusion and exclusion criteria.According to the oc-currence of FGR,PE patients were divided into the FGR group(708)and non-FGR group(3383).According to the diagnostic sequence of FGR and hypertension,FGR patients were divided into the first FGR group(438)and the first hypertension with FGR group(270).Patients with hypertension as the first symptom in the non-FGR group were included in the first hypertension without FGR group(3027).The clinical characteristics and perinatal outcomes were compared.Results(1)The pre-pregnancy BMI of first FGR group,first hypertension with FGR group and the first hy-pertension without FGR group were 21.88±3.18,22.53±3.42,23.23±3.62.The proportion of family history of hyperten-sion was 11.6％,18.9％,14.1％,respectively(P＜0.05).(2)Compared with the first hypertension with FGR group,in the first FGR group,the gestational week of PE diagnosis was late;the interval between diagnosis of FGR and hyperten-sion was longer,the internal between diagnosis of FGR and severe FGR was longer,and the interval between diagnosis of FGR and pregnancy termination was also longer(P＜0.05).(3)Univariate analysis showed that there were significant dif-ferences in the incidence of pregnancy complications among the three groups(P＜0.05).Multivariate regression analysis adjusted for confounding factors showed that there was no significant difference in the risk of pregnancy complications be-tween the first FGR group and the first hypertension with FGR group(P＞0.05).However,there were significant differ-ences in multiple indicators of pregnancy termination among the three groups(P＜0.05).(4)Univariate analysis showed that there were significant differences in neonatal outcomes among the three groups(P＜0.05).Multivariate regression analysis adjusted for confounding factors showed that compared with the first FGR group,newborns in the first hyperten-sion with FGR group had lower body weight(P＜0.05).(5)In the first FGR group,univeriate analysis showed that the number of prenatal examinations,prenatal edema,the levels of albumin,serum calcium,blood pressure,hemoglobin platlet,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase and uric acid levels before delivery had statistical differences among the 3 groups(P＜0.05).Rregression analysis showed that there was a positive correla-tion between neonatal outcome indexes and the number of prenatal examinations,albumin,serum calcium levels in the first FGR group;while there was a negative correlation between neonatal putcome indexes and prenatal edema,blood pressure,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase and uric acid levels in the first FGR group(P＜0.05).Conclusions FGR is a preclinical sign of PE.This study suggests it is a long time for clinical management of FGR before showing all diagnostic criteria of PE.It is necessary to strengthen the monitoring of blood pressure and PE related clinical manifestations in FGR to delay or reduce the occurrence of PE.Both the first FGR group and the first hypertension with FGR group are prone to placenta-fetal involvement and risk,and attention should be paid to placenta-fetal function monitoring.PE patients with first FGR or hypertension have different clinical characteristics and perinatal outcomes,and clinical management should be personalized based on the heterogeneity of PE pregnant women.
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