胎儿生长受限的病因及对患儿远期健康的影响

doi:10.12280/gjfckx.20230840

摘要/Abstract

摘要：

胎儿生长受限（fetal growth restriction，FGR）是指胎儿在妊娠期内无法达到其预期的生长潜力，其是妊娠期常见且较复杂的并发症之一。FGR病因复杂多样，可能是由母体、胎儿或胎盘因素所引起。对于存在FGR的儿童和成年患者，长期的追踪研究揭示了其健康状况的不良后果。生长受限胎儿的出生体质量和身长明显落后于正常儿童，绝大部分患儿在生后早期即开始出现明显的生长追赶，但其存在更高的代谢问题风险。FGR常常伴随着一系列的远期并发症，如神经系统发育障碍和骨骼肌生长代谢异常等问题，甚至是在成年期时更易出现代谢综合征和心血管疾病，这对患儿的身体健康和生活质量产生了严重影响。综述FGR致病因素及对患儿远期健康的影响，以期为临床防治提供相关理论支持。

关键词: 胎儿生长迟缓, 胚胎发育, 神经发育障碍, 肌肉骨骼发育, 代谢综合征

Abstract:

Fetal growth restriction (FGR) is one of the common and more complex complications of pregnancy, which refers to the inability of the fetus to reach its expected growth potential during pregnancy. The etiology of FGR is complex and varied, and may be caused by maternal, fetal or placental factors. Long-term follow-up studies of pediatric and adult patients with FGR have revealed adverse health outcomes. Fetuses with growth restriction lag significantly behind normal children in birth weight and length after delivery, and the vast majority of these children begin to experience significant growth catch-up early in life, but are at higher risk for metabolic problems. FGR is often associated with a range of long-term complications, such as neurologic deficits and abnormalities in skeletal muscle growth and metabolism, and is even associated with increased risk of metabolic syndrome and cardiovascular disease in adulthood. This has a serious impact on the physical health and quality of life of children with FGR. We summarize the pathogenic factors of FGR and its effects on the long-term health of children in order to provide theoretical support for the clinical prevention and treatment of FGR.

Key words: Fetal growth retardation, Embryonic development, Neurodevelopmental disorders, Musculoskeletal development, Metabolic syndrome

王雅慧, 王艳, 王艳, 裴飞. 胎儿生长受限的病因及对患儿远期健康的影响[J]. 国际妇产科学杂志, 2024, 51(2): 152-156.

WANG Ya-hui, WANG Yan, WANG Yan, PEI Fe. The Etiology of Fetal Growth Restriction and Its Effects on the Long-Term Health of the Child[J]. Journal of International Obstetrics and Gynecology, 2024, 51(2): 152-156.

图/表 1

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分类	致病因素
母体因素	孕前糖尿病、肾功能不全、自身免疫性疾病、紫绀性心脏病、慢性高血压、子痫前期、妊娠期高血压、母体营养不良、抗磷脂抗体综合征、获得性免疫介导血栓形成倾向、物质滥用（如烟草、酒精、可卡因、麻醉剂）、暴露于致畸物（如环磷酰胺、丙戊酸、抗血栓药）等
胎儿因素	染色体异常（13、18、21-三体综合征）、先天性心脏病、腹裂、胎儿感染（如巨细胞病毒、风疹、单纯疱疹、艾滋病毒、梅毒、疟疾、弓形虫）、多胎妊娠、胎产次等
胎盘因素	胎盘功能不全、胎盘早剥、胎盘梗死、轮状胎盘、胎盘血管瘤、绒毛血管瘤、脐带异常（如过长、过细、扭曲、真结、单脐动脉、扁平脐带、脐带帆状附着、胎盘边缘附着）等

分类	致病因素
母体因素	孕前糖尿病、肾功能不全、自身免疫性疾病、紫绀性心脏病、慢性高血压、子痫前期、妊娠期高血压、母体营养不良、抗磷脂抗体综合征、获得性免疫介导血栓形成倾向、物质滥用（如烟草、酒精、可卡因、麻醉剂）、暴露于致畸物（如环磷酰胺、丙戊酸、抗血栓药）等
胎儿因素	染色体异常（13、18、21-三体综合征）、先天性心脏病、腹裂、胎儿感染（如巨细胞病毒、风疹、单纯疱疹、艾滋病毒、梅毒、疟疾、弓形虫）、多胎妊娠、胎产次等
胎盘因素	胎盘功能不全、胎盘早剥、胎盘梗死、轮状胎盘、胎盘血管瘤、绒毛血管瘤、脐带异常（如过长、过细、扭曲、真结、单脐动脉、扁平脐带、脐带帆状附着、胎盘边缘附着）等