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.
Objective-Society for Maternal-Fetal Medicine guidelines for diagnosing fetal growth restriction (FGR) have broadened the definition to include abdominal circumference (AC) <10 th percentile for gestational age (GA) regardless of estimated fetal weight (EFW). We aimed to compare the ability of three definitions of FGR to predict small for gestational age (SGA) neonates and adverse outcomes.Methods-We performed a secondary analysis of a prospective cohort of patients who underwent assessment of fetal growth between GA of 26 and 36 weeks. We compared three definitions of FGR: EFW <10 th percentile; AC <10 th percentile; either EFW or AC <10 th percentile. The primary outcome was successful prediction of neonatal SGA. Secondary outcomes included a composite adverse neonatal outcome (CANO). We further compared these definitions of FGR using area under receiver operative curves (AUC) to measure their discriminatory abilities.Results-About 1054 women met inclusion criteria. Ninety-one (8.6%) had EFW <10 th percentile, 122 (11.6%) had AC <10 th percentile, and 137 (12.9%) had either EFW or AC <10 th percentile. SGA was seen in 139 (13.2%); CANO was seen in 139 (13.2%). Ability for detecting neonatal SGA was significantly better when the definition included both EFW or AC <10 th percentile compared to either variable independently. The AUC were: 0.74, 0.73, 0.69; P = .0003. There was no statistical significance in ability for predicting CANO (AUC 0.51, 0.51, 0.50; P = .7447).Conclusions-Addition of AC as a criterion for diagnosing FGR improves our ability to predict neonatal SGA compared to using EFW alone. All three definitions were poorly predictive of neonates at risk for adverse outcomes.
Background Congenital malformations and adverse fetal outcomes secondary to teratogenic exposures are major public health concerns. We review all inquiries made to the Florida MotherToBaby service center as well as the novel Exposure Clinic, which offers direct patient counseling. Methods We completed a retrospective review of all inquiries made to the MotherToBaby Florida service and the Exposure Clinic consults between its inception January 2019 through December 2021. All de‐identified data was collected at the time of the inquiry and stored in the OTIS database. Aggregate data was then extracted and descriptive statistics were performed. A p value of less than .05 indicated statistical significance. Results In 2019, there were 163 total inquiries, 265 in 2020, and 1,279 in 2021. These 1,707 inquiries covered 2,809 unique exposures. In the Exposure Clinic, 49 patients were seen in 2019, 140 in 2020, and 263 in 2021. The clinic's geographical reach increased over time with patients from 22 different counties being seen in 2021. Of all individual exposures, 45% were evaluated in 452 unique encounters in the Exposure Clinic and 55% were evaluated in 1255 unique encounters via traditional modes of contact. The average number of exposures discussed at each clinic appointment 2.8 versus 1.2 in inquiries via traditional methods. The majority of all exposures were regarding prescription medications, specifically psychiatric medications, followed by immunizations. The exposure with the single most inquiries was the COVID‐19 vaccine. Conclusions This novel clinic structure allows for complex counseling and clinical recommendations regarding exposures during pregnancy.
We thank Prof. Lees and his colleagues for their comments regarding our study 1 in which we endeavored to apply the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) 2 and Society for Maternal-Fetal Medicine (SMFM) 3 definitions of fetal growth restriction (FGR) to a pre-existing cohort of patients with the aim of comparing their performance in predicting neonatal small-for-gestational age (SGA) and composite adverse neonatal outcome. As outlined in the Discussion, our study has limitations.In table S1 of the study, we report that six of the 53 fetuses with late-onset FGR according to the ISUOG definition had estimated fetal weight (EFW) or fetal abdominal circumference (AC) crossing centiles of more
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