Prenatal alcohol exposure often results in an array of fetal developmental abnormalities termed fetal alcohol spectrum disorders (FASDs). Despite the high prevalence of FASDs, the pathophysiology of fetal damage by alcohol remains poorly understood. One of the major obstacles in studying fetal development in response to alcohol exposure is the inability to standardize the amount, pattern of alcohol consumption, and peak blood alcohol levels in pregnant mothers. In the present study, we used Doppler ultrasonography to assess fetal growth and cardiovascular parameters in response to alcohol exposure in pregnant baboons. Baboons were subjected to gastric alcohol infusion 3 times during the second trimester equivalent to human pregnancy, with maternal blood alcohol levels reaching 80 mg/dL within 30 to 60 minutes following alcohol infusion. The control group received a drink that was isocaloric to the alcohol-containing one. Doppler ultrasonography was used for longitudinal assessment of fetal biometric parameters and fetal cardiovascular indices. Fetal abdominal and head circumferences, but not femur length, were significantly decreased in alcohol-exposed fetuses near term. Peak systolic velocity of anterior and middle cerebral arteries decreased during episodes of alcohol intoxication, but there was no difference in Doppler indices between groups near term. Acute alcohol intoxication affected fetal cerebral blood flow independent of changes in the fetal cardiac output. Unlike fetal growth parameters, changes in vascular indices did not persist over gestation. In summary, alcohol effects on fetal growth and on fetal vascular function have different time courses.

This is the first study to compare the performance of the Society for Maternal-Fetal Medicine (SMFM) and International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) definitions of fetal growth restriction (FGR) in predicting small-for-gestational age (SGA) at birth and composite adverse neonatal outcome (ANO) using a large dataset. While the ISUOG definition had a higher specificity, the SMFM definition had a higher sensitivity for predicting a SGA neonate. Both definitions had poor performance for predicting composite ANO. What are the clinical implications of this work?In deciding whether to use the SMFM or ISUOG definition of FGR, the trade-off between sensitivity and specificity for predicting SGA at birth must be balanced.

fetal weight (EFW) improve the prediction of LGA infants when compared to using Hadlock EFW. STUDY DESIGN: This was a secondary analysis of data from a prospective study of women referred for growth ultrasounds during the 3 rd trimester. Growth trajectories (reported as change in Z-scores) for AC and EFW were derived from the difference in Z-scores between measurements at the time of anatomy survey (18-22 week) and third trimester ultrasound (26-36 weeks). Change in AC and EFW growth trajectories >90 th %ile alone or in combination with prenatally suspected LGA from EFW defined using Hadlock chart > 90 th %ile were compared for prediction of a LGA neonate. The primary outcome was the sensitivity and specificity of the growth trajectories for the prediction of neonatal LGA (Birth weight > 90 th % ile using chart by Alexander et al). Logistic regression was used to determine if the growth trajectory improved the performance of predicting neonatal LGA. Area under the ROC curve (AUC) was also determined. RESULTS: Of 622 women meeting inclusion criteria, 85 (13.7%) were diagnosed as LGA neonates. The test characteristics for the biometric trajectories and Hadlock EFW are shown in the Table. Standard Hadlock EFW showed a better NPV (98%) and sensitivity (71.1%) when compared to AC growth trajectory (NPV 87.5%, sensitivity 17.7%) and EFW growth trajectory (NPV 88.1%, sensitivity 22.6%). The AUC using AC growth trajectory was 0.54; 0.57 for EFW growth trajectory; and 0.65 using Hadlock EFW. The AUC did not significantly improve (0.68) when the growth trajectories were combined with Hadlock EFW. Adjustment for the Z-scores for gestational age at anatomy scan or 3 rd trimester growth scan did not change these results. The OR using Hadlock EFW was higher than the other measures. CONCLUSION: AC and EFW growth trajectories do not appear to improve the prediction of LGA infants when compared to using the third trimester EFW.

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