Should fetal growth be a matter of concern in isolated single umbilical artery?

Abstract

Should fetal growth be a matter of concern in iSolated Single umbilical artery? rev aSSoc med braS 2014; 60(2):125-130 125original articleShould fetal growth be a matter of concern in isolated single umbilical artery? Conflict of interest: noneObjective: To examine birth weight in pregnancies with isolated single umbilical artery (ISUA). Methods: Case control study with retrospective review of 131 singleton pregnancies with isolated single umbilical artery diagnosed before birth. Control group consisted of 730 singleton pregnancies recruited prospectively, that had histological confirmation of a 3 vessels cord. Pregnancies were classified as uncomplicated or high-risk according to the presence of diseases that increase the risk of placental insufficiency during pregnancy. Mean birth weight and frequency of low birth weight (< 2.500 g), very low birth weight (< 1.500 g) and fetal growth restriction below the 5 th and 10 th centiles were compared between groups. Results: Mean birth weight difference between ISUA (n=131, 2840±701g) and control (n=730, 2.983 ± 671g) pregnancies was 143g (95% CI= 17-269; p=0.04) and birth weight below the 5 th centile was significantly more common in ISUA group [28/131 (21.4%) versus 99/730 (13.6%), p=0.02]. When only uncomplicated pregnancies were considered in both groups, no birth weight differences were observed. Amongst high-risk subgroups, birth weight below the 5 th centile remained significantly more common in ISUA compared to control pregnancies [10/35 (28.6%) versus 53/377 (14.1%), p=0.04]. Conclusion: Isolated single umbilical artery does not increase the risk of fetal growth restriction in uncomplicated singleton pregnancies.

Association Between Isolated Single Umbilical Artery and Perinatal Outcomes: A Meta-Analysis

“…However, for placental weight, the results of two previous studies [ 5 , 15 ] were opposite to that of our meta-analysis; the false positive in these two previous studies might be partially responsible for the inconsistency, and our meta-analysis might have eliminate the false positive by enlarging the sample size. With respect to perinatal complications, our results were in accordance with those of previous studies [ 1 , 11 – 13 , 18 , 24 , 25 ].…”

“…We performed subsequent subgroup analysis stratified by study type for gestational age and PIH. Our results ( Figures 2A , 5C ) showed that the two prospective case-control study [ 5 , 23 ] might be the source of heterogeneity for gestational age; and heterogeneity for PIH might have resulted from one retrospective case-control study [ 24 ]. Thus, we suggest that when pooling eligible studies for meta-analysis, the heterogeneity of different study types should be considered, and subgroup analysis based on study type should be performed if sufficient data is available.…”

Prenatally Diagnosed Single Umbilical Artery (SUA) – Retrospective Analysis of 1169 Fetuses

“…Interestingly, Caldas et al who had performed serial fetal growth scans in all women with iSUA in their collective could show that the scans were only necessary in case of maternal disease or pregnancy complications with an increased risk of placental insufficiency such as hypertension, cardiomyopathy, anemia, diabetes or thrombophilia [28]. One explanation for unrestricted growth development in children with iSUA without any further ▶ risks of placental insufficiencies could be a compensatory increase of the persistent artery diameter during pregnancy.…”

Single umbilical artery and reproduction losses in Slovak population: relation to karyotype and fetal anomalies

“…Rembouskos (28) specifi es the occurrence of SUA in the 1st trimester (11)(12)(13)(14) week gestation) to be 5.9 %. In this study, the occurrence is lower, which can be caused by the small number of received samples in the 1st trimester.…”

“…While some studies have evidenced an increased incidence of fetal growth restriction and adverse outcome (3,11), other investigations found no difference in the fetal growth restriction in comparison with a normal three-vessel cord (12,13). Isolated SUA does not increase the risk of fetal growth restriction in uncomplicated singleton pregnancies (14). However, 30-60 % of fetuses with SUA will have associated anomalies or chromosomal abnormalities.…”