Detection of growth‐restricted fetuses during pregnancy is associated with fewer intrauterine deaths but increased adverse childhood outcomes: an observational study

Andreasen, Lisbeth Anita; Tabor, Ann; Nørgaard, Lone Nikoline; Rode, Line; Gerds, Thomas Alexander; Tolsgaard, Martin G.

doi:10.1111/1471-0528.16380

Cited by 16 publications

(17 citation statements)

References 26 publications

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“…It was surprising to find no difference in neurological outcomes between the two groups of severe FGR, similar to a previous report 16 . The concern then is whether detection carries any benefit for longer‐term childhood outcomes 17 …”

Section: Discussionsupporting

confidence: 68%

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Does detection of fetal growth restriction improve neonatal outcomes?

Selvaratnam

Wallace

Treleaven

et al. 2020

J Paediatrics Child Health

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Aim Timely delivery of fetal growth restriction (FGR) is a balance between avoiding stillbirth and minimising prematurity. We sought to assess the neonatal outcomes for babies suspected of FGR, both true and false positives. Methods This population cohort study examined all singleton births in Victoria, Australia from 2000 to 2017 (n = 1 231 415). Neonatal morbidities associated with neonatal intensive care unit (NICU) admission were assessed for babies born ≥32 weeks' with severe FGR (<3rd centile) and babies with birthweight ≥10th centile who were iatrogenically delivered for suspected FGR. Results Babies with severe FGR iatrogenically delivered for suspected FGR were more likely to require NICU admission than babies with severe FGR who were not detected (3.0% vs. 1.1%, P < 0.001). After adjusting for potential confounders, the odds of NICU admission were increased (adjusted odds ratio (aOR) = 3.00, 95% confidence interval = 2.45–3.67; P < 0.001). Rates of NICU admission were also higher in ≥10th centile babies iatrogenically delivered for suspected FGR than for ≥10th centile babies who entered labour spontaneously (1.8% vs. 0.5%, P < 0.001). After adjustments, the odds of NICU admission were increased (aOR = 3.91, 95% confidence interval = 3.40–4.49; P < 0.001). NICU admissions were associated with morbidities related to iatrogenic prematurity. Conclusions Detection and planned delivery of FGR reduces stillbirth but may be associated with increased neonatal morbidity related to iatrogenic prematurity.

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Section: Discussionsupporting

confidence: 68%

“…16 The concern then is whether detection carries any benefit for longer-term childhood outcomes. 17 Whether or not early birth is responsible for the poorer neonatal outcomes, these results are not entirely unwelcome. The main goal of FGR detection is to prevent mortality, which is being achieved.…”

Section: Discussionmentioning

confidence: 99%

Does detection of fetal growth restriction improve neonatal outcomes?

Selvaratnam

Wallace

Treleaven

et al. 2020

J Paediatrics Child Health

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“…It is increasingly recognized that improved clinical management of FGR is urgent as current models of screening lack efficacy and only between 31% and 38% of pregnancies are identified before birth, notably in high income settings with available antenatal care programs and selective or universal ultrasonography monitoring [26,27]. In this perspective, the predictive performance of the biosensor should be assessed as a potential future method embracing several current challenges.…”

Section: Discussionmentioning

confidence: 99%

Biosensor for Detecting Fetal Growth Restriction in a Low-Resource Setting

Jacobsen¹,

Schmiegelow

Sørensen

et al. 2021

Reprod. Med.

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One strategy for improving detection of fetal growth restriction (FGR) is developing biosensors identifying placental dysfunction as a leading pathogenesis for FGR. The aim of this pilot study was to investigate the performance of a biosensor specified to detect placental dysfunction by means of maternal arterial turbulence acoustics in a low-resource setting. A cohort of 147 singleton pregnant women were prospectively followed with double-blinded biosensor tests, sonographic estimation of fetal weight (EFW) and Doppler flow at 26–28, 32–34 and 37–39 weeks of pregnancy. Full term live births with recorded birth weights (BWs) and without major congenital malformations were included. Outcomes were defined as (A) a solitary biometric measure (BW < 3rd centile) and as (B) a biometric measure and contributory functional measure (BW < 10th centile and antenatally detected umbilical artery pulsatility index > 95th centile). Data from 118 women and 262 antenatal examinations were included. Mean length of pregnancy was 40 weeks (SD ± 8 days), mean BW was 3008 g (SD ± 410 g). Outcome (A) was identified in seven (6%) pregnancies, whereas outcome (B) was identified in one (0.8%) pregnancy. The biosensor tested positive in five (4%) pregnancies. The predictive performance for outcome (A) was sensitivity = 0.29, specificity = 0.97, p = 0.02, positive predictive value (PPV) was 0.40 and negative predictive value (NPV) was 0.96. The predictive performance was higher for outcome (B) with sensitivity = 1.00, specificity = 0.97, p = 0.04, PPV = 0.20 and NPV = 1.00. Conclusively, these pilot-study results show future potential for biosensors as screening modality for FGR in a low-resource setting.

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“…In the present study also HDsP contributed to a higher LBW number. In the study by Andreasen et al which explored association between antenatal detection of FGR and adverse outcome and found that the detection of FGR and risk of adverse childhood conditions, possibly caused by prematurity [26]. Iatrogenic prematurity may be inevitable in stillbirth prevention, but is accompanied by a risk of long-term childhood conditions.…”

Section: Discussionmentioning

confidence: 99%

Community Based Study of Preterm Births, Small for Gestation and Low Birth Weight Babies in Rural Tribal Women with Extreme Poverty

2021

JPNB

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Background: Globally one-sixth of new-borns are Low Birth Weight (LBW), single most important risk factor for Neonatal deaths (NNDs), Preterm births (PTB), Small for gestational age (SGA), Foetal Growth Restriction (FGR) are responsible for LBW and most of perinatal mortality. Objective: Present community-based study was carried out to know burden of PTB, SGA, LBW babies among rural, tribal women. Material and Methods: After ethics committee’s approval prospective study was conducted in 100 villages. Results: Over 2 years, 3713 women delivered, 2287 (61.6%) babies were LBW, 239 (6.4%) PT, 165 (69%) PT SGA, 916 (26.4%) of 3474 term babies were SGA. Overall 26.4% babies were <2 kg, 32.5% ≥2 to <2.5 kg, only 38.4% babies ≥2.5 kg. Of 55 mothers who had very very very (VVV) LBW (<1 kg) babies, 4 (7.3%) had hypertensive disorders of pregnancy (HDsP), 45 (81.8%) anaemic 3 (5.5%) had other disorders, 3 (5.5%) had no obvious disorder (P-value 0.7754). Of 129 women with VVLBW (≥1 to <1.5 kg) babies, 10 (7.8%) had HDsP,107 (83.9%) anaemia, 9 (7.0%) other disorders, 3 (2.3%) had no obvious disorder (P-value 0.4842). Of 895 women with VLBW (≥1.5 to <2 kg) babies, 84 (9.4%) mothers had HDsP,733 (81.9%) anaemia, 49 (5.5%) other disorders, 29 (3.2%) no obvious disorder (P-value<0.0001). Of 1208 women with babies of ≥2 to <2.5 kg babies, 112 (9.3%) had HDsP, 971(80.4%) had anaemia, 87 (7.2%) other disorders, 38 (3.1%) no obvious disorder (P-value 0.0205). There were 6.4% perinatal deaths 7.4% amongst 2287 <2.5kg, 4.8% of 1426 ≥2.5kg (P-value 0.0085). Conclusion: Preterm births were not high but many babies were LBW, only 38.4% NW, 69% PT and 26.4% term babies were SGA. Anaemia seemed to be a major contributor

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Detection of growth‐restricted fetuses during pregnancy is associated with fewer intrauterine deaths but increased adverse childhood outcomes: an observational study

Abstract: Objective Exploring associations between antenatal detection of fetal growth restriction (FGR) and adverse outcome.

Cited by 16 publications

References 26 publications

Does detection of fetal growth restriction improve neonatal outcomes?

Does detection of fetal growth restriction improve neonatal outcomes?

Biosensor for Detecting Fetal Growth Restriction in a Low-Resource Setting

Community Based Study of Preterm Births, Small for Gestation and Low Birth Weight Babies in Rural Tribal Women with Extreme Poverty

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