Does the Presence of Risk Factors for Fetal Growth Restriction Increase the Probability of Antenatal Detection? A <scp>F</scp>rench National Study

Monier, Isabelle; Blondel, Béatrice; Ego, Anne; Kaminski, Monique; Goffinet, François; Zeitlin, Jennifer

doi:10.1111/ppe.12251

Cited by 29 publications

(27 citation statements)

References 39 publications

(99 reference statements)

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“…First, because almost all women have a third‐trimester scan in France, there may be less of a socioeconomic gradient associated with detection. Previous French studies of antenatal detection of FGR and of congenital heart defects have shown that sociodemographic factors are not related to detection. While cases were more likely to be immigrants and less likely to be employed than were controls, the proportions which received a third‐trimester scan were similar and nearly 80% of stillbirths which did not have FGR detected occurred in women who had undergone all three recommended routine scans.…”

Section: Discussionmentioning

confidence: 99%

Antenatal detection of fetal growth restriction and risk of stillbirth: population‐based case–control study

Ego

Monier

Skaare

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? This population-based study reports a smaller protective effect against stillbirth of detection of fetal growth restriction (FGR) than previous studies, with over 40% of stillbirths among small-for-gestational-age (SGA) fetuses occurring despite detection of FGR. What are the clinical implications of this work?In the context of universal ultrasound screening, these findings raise the possibility that routine examination may be less efficacious than is sonography indicated based on risk-factor criteria. They call into question focusing solely on improving detection of FGR without addressing management post-detection. Preventive strategies targeting all stillbirths may ultimately have a larger impact on the risks of SGA-related as well as other stillbirths. ABSTRACTObjectives Antenatal surveillance of intrauterine growth aims to detect growth-restricted fetuses (FGR), which face increased risk of stillbirth. Improving their detection could be an effective strategy for prevention of stillbirth. The French REPERE study was conducted to estimate the association between antenatal detection of FGR and risk of stillbirth.Methods REPERE is a case-control study performed in three French districts with a combined total of approximately 30 000 births annually. Cases were singleton small-for-gestational-age (SGA) stillbirths ≥ 24 weeks' gestation and without severe congenital anomaly, between 2012 and 2014, identified using a population-based stillbirth registry; controls were live births fulfilling the same Results During the study period, there were 92 182 births ≥ 22 weeks' gestation, including 669 stillbirths, of which 79 were singleton SGA stillbirths ≥ 24 weeks and without severe congenital anomaly. Of these cases, 44.3% (35/79) had FGR detected, compared with a detection rate of 36.2% in controls (154/426). The crude OR expressing the association between detection of FGR and risk of stillbirth was 1.4 (95% CI, 0.9-2.3) and the OR adjusted for parity, presence of risk factors for FGR, presence of vascular disorder and birth-weight percentile was 0.6 (95% CI, 0.3-1.0). Among deliveries ≥ 28 weeks, detection rates were 38.3% vs 36.0% for cases and controls, with an adjusted OR of 0.5 (95% CI, 0.2-1.0).Conclusion Antenatal detection of FGR was protective against stillbirth, but over 40% of stillbirths among SGA

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Section: Discussionmentioning

confidence: 99%

Antenatal detection of fetal growth restriction and risk of stillbirth: population‐based case–control study

Ego

Monier

Skaare

et al. 2020

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

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“…[11] A recent French study (N=14 100) highlighted difficulties with the detection of fetal growth restriction even in the presence of obstetric and medical risk factors for the condition, and suggested that better risk assessment could improve antenatal identification. [12] In SA ~50% of stillbirths occur in a seemingly healthy mother who does not present with any clinical complications antenatally. [13] Maternal complications are also not increased in SGA stillbirths RESEARCH compared with AGA and large-for-gestational-age (LGA) stillbirths.…”

Section: Researchmentioning

confidence: 99%

“…In highincome countries, it is estimated that up to 76% of SGA cases can be detected during the antenatal period; [25] however, other studies have reported on difficulties of detecting IUGR. [12] Limited resources in LMICs mean that palpation and fundal height are commonly used methods to predict growth restriction, despite little evidence to support their effectiveness. [10] The detection of fetuses at risk of stillbirth is further complicated by the fact that ~50% occur in a seemingly healthy mother, with no increase in the proportion of unhealthy mothers in SGA pregnancies.…”

Section: Researchmentioning

confidence: 99%

Stillbirth risk across pregnancy by size for gestational age in Western Cape Province, South Africa: Application of the fetuses-at-risk approach using perinatal audit data

et al. 2019

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Background. There is little published work on the risk of stillbirth across pregnancy for small-for-gestational-age (SGA) and large-forgestational (LGA) pregnancies in low-resource settings. Objectives. To compare stillbirth risk across pregnancy between SGA and appropriate-for-gestational-age (AGA) pregnancies in Western Cape Province, South Africa (SA). Methods. A retrospective audit of perinatal mortality data using data from the SA Perinatal Problem Identification Program was conducted. All audited stillbirths with information on size for gestational age (N=677) in the Western Cape between October 2013 and August 2015 were included in the study. The Western Cape has antenatal care (ANC) appointments at booking and at 20, 26, 32, 34, 36, 38 and 41 (if required) weeks' gestation. A fetuses-at-risk approach was adopted to examine stillbirth risk (28 -42 weeks' gestation, ≥1 000 g) across gestation by size for gestational age (SGA <10th centile Theron growth curves, LGA >90th centile). Stillbirth risk was compared between SGA/LGA and AGA pregnancies. Results. SGA pregnancies were at an increased risk of stillbirth compared with AGA pregnancies between 30 and 40 weeks' gestation, with the relative risk (RR) ranging from 3.5 (95% confidence interval (CI) 1.6 -7.6) at 30 weeks' gestation to 15.3 (95% CI 8.8 -26.4) at 33 weeks' gestation (p<0.001). The risk for LGA babies increased by at least 3.5-fold in the later stages of pregnancy (from 37 weeks) (p<0.001). At 38 weeks, the greatest increased risk was seen for LGA pregnancies (RR 6.6, 95% CI 3.1 -14.2; p<0.001). Conclusions. There is an increased risk of stillbirth for SGA pregnancies, specifically between 33 and 40 weeks' gestation, despite fortnightly ANC visits during this time.LGA pregnancies are at an increased risk of stillbirth after 37 weeks' gestation. This high-risk period highlights potential issues with the detection of fetuses at risk of stillbirth even when ANC is frequent.

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“…Vale ressaltar que não consta das diretrizes do pré-natal no Brasil 19 o monitoramento via ultrassonografia para o crescimento intrauterino, conforme recomendado em outros países, como França e Canadá 32,33 . O acréscimo desse procedimento pode ampliar a detecção do CIR e tornar mais eficaz o pré-natal no controle desse desfecho.…”

Section: Considerações éTicasunclassified

Adequação do peso ao nascer para idade gestacional de acordo com a curva INTERGROWTH-21 st e fatores associados ao pequeno para idade gestacional

et al. 2018

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Resumo Introdução Apesar do conhecimento sobre a etiologia multifatorial do crescimento intrauterino restrito, há escassez de estudos nacionais. Objetivo Estimar a adequação do peso ao nascer para idade gestacional e investigar fatores associados ao recém-nascido pequeno para idade gestacional (RN-PIG), com destaque para tabagismo e pré-natal. Método Estudo seccional em maternidades públicas no Rio de Janeiro e em Niterói, em 2011, com 1.771 nascidos vivos. Foram realizadas entrevistas com puérperas e consultas em prontuários. Estimaram-se prevalências e intervalos de confiança (IC95%) de recém-nascido pequeno para idade gestacional (RN-PIG), recém-nascido adequado para idade gestacional (RN-AIG) e recém-nascido grande para idade gestacional (RN-GIG), usando a curva INTERGROWTH-21st , segundo características maternas, da gestação e do recém-nascido. Utilizou-se regressão de Poisson, com o desfecho sendo nascer PIG. Resultados As prevalências foram de 9,3% para PIG e de 15,9% para GIG. Cor parda (RP = 1,4), baixa escolaridade (RP = 1,3), inadequação de pré-natal (RP = 1,3), tabagismo (redução/cessação: RP = 1,7; continuidade: RP = 2,4) e hipertensão arterial (RP = 1,3) foram associados ao PIG na análise univariada (p < 0,20), e apenas tabagismo manteve-se associado no modelo final (redução/cessação: RP = 1,7 e continuidade: RP = 2,3; p < 0,05). Conclusão A prevalência de PIG mostrou um efeito dose-resposta com o tabagismo. Estratégias populacionais antitabaco devem intensificar a prevenção direcionada às mulheres em idade fértil e, particularmente, às gestantes, com ações específicas para estímulo à cessação no pré-natal.

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Does the Presence of Risk Factors for Fetal Growth Restriction Increase the Probability of Antenatal Detection? A French National Study

Abstract: Our results suggest that better risk assessment could improve antenatal identification of FGR. Sex-specific fetal growth references should be used to avoid systematic bias linked to sex.

Cited by 29 publications

References 39 publications

Antenatal detection of fetal growth restriction and risk of stillbirth: population‐based case–control study

Antenatal detection of fetal growth restriction and risk of stillbirth: population‐based case–control study

Stillbirth risk across pregnancy by size for gestational age in Western Cape Province, South Africa: Application of the fetuses-at-risk approach using perinatal audit data

Adequação do peso ao nascer para idade gestacional de acordo com a curva INTERGROWTH-21 st e fatores associados ao pequeno para idade gestacional

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