Evaluation and Management of Suspected Fetal Growth Restriction

Bruin, Claartje; Damhuis, Stefanie Elisabeth; Gordijn, Sanne J.; Ganzevoort, Wessel

doi:10.1016/j.ogc.2021.02.007

Cited by 10 publications

(5 citation statements)

References 64 publications

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“…6,16,20,21 Placental size and function also impact foetal growth and health. 22,23 We observed relatively large placentas despite maternal smoking, which is typically associated with small placentas and birth sizes. These large size of the placentas was linked to maternal methadone treatment, concomitant substance use, and hepatitis C, which is in line with previous research.…”

Section: Discussionmentioning

confidence: 72%

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Intrauterine exposure to maternal opioid maintenance treatment and associated risk factors may impair child growth

Kanervo,

Luoto,

Tupola

et al. 2024

Acta Paediatrica

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AimHow maternal opioid maintenance treatment (OMT) affects children is under‐researched. This population‐based registry study investigated child growth and somatic health following intrauterine exposure to this treatment.MethodsChildren born between 1 March 2011 and 30 May 2021 to mothers who used buprenorphine, buprenorphine‐naloxone, or methadone throughout their pregnancies were followed for 2 years at the Helsinki University Hospital, Finland. Appropriate statistical tests were used to compare the treatment groups.ResultsOf the 67 neonates, 52% were male, 96% were born full‐term and 63% were treated for neonatal opioid withdrawal syndrome. Otherwise, the children were predominantly healthy, although relatively small: 22% were small for gestational age, the methadone group children being the smallest. Foetal exposure to maternal methadone treatment, illicit drugs, hepatitis C and smoking were associated with small for gestational age; the former two were also associated with later slower growth, especially head growth and weight gain (p < 0.001). However, 29% were overweight at 2 years.ConclusionUsing child growth as the outcome, we found that buprenorphine‐naloxone and buprenorphine‐monotherapy had equal effects as forms of maternal OMT. Exposure to multiple risk factors may harm foetal and subsequent growth. We recommend long‐term follow‐up of children exposed to maternal OMT.

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Section: Discussionmentioning

confidence: 72%

“…Placental size and function also impact foetal growth and health 22,23 . We observed relatively large placentas despite maternal smoking, which is typically associated with small placentas and birth sizes.…”

Section: Discussionmentioning

confidence: 73%

Intrauterine exposure to maternal opioid maintenance treatment and associated risk factors may impair child growth

Kanervo,

Luoto,

Tupola

et al. 2024

Acta Paediatrica

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“…One of the leading theories of placental insufficiency is vascular-endothelial dysfunction theory. Endothelial cells of vessels synthesize a large number of biologically active substances that are involved in provid-ing a variety of processes in the physiological and pathological gestational processes [2,4,6,24].…”

Section: н а д о п о м о г у л і к а р ю -п р а к т и к уmentioning

confidence: 99%

Prediction of the development of fetal growth retardation in pregnant women with chronic arterial hypertension

Deinichenko

Syusyuka

Krut

et al. 2022

RHW

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During intrauterine life a fetus with growth restriction does hemodynamic, metabolic and hormonal adjustments to cope with the adverse uterine environment, and these changes can become permanent and irreversible. Despite the progress in the knowledge of delayed fetal development, the biomarkers are able to identify this pathology at an early stage and stratify its severity, both before and after childbirth, are still not determined. The objective: to evaluate the prognostic value of the angiogenesis marker level, hormonal profile and Doppler examination for fetal growth restriction (FGR) in pregnant women with chronic arterial hypertension (CAH).Materials and methods. A prospective examination of 61 pregnant women with CAH 1-2 degrees was conducted, which included an analysis of the clinical and anamnestic characteristics and the study of the pregnancy course in the first trimester (11-12 weeks). To determine the level of risk factors for the FGR development the examined pregnant women were divided into groups: women with CAH with FGR (n=10), and pregnant women with CAH without FGR (n=51).Human chorionic gonadotropin (CHG), progesterone (PG) and estradiol (E) were determined in blood serum. Angiogenesis markers – placental growth factor (P1GF) as a pro-angiogenic factor and soluble fms-like tyrosine kinase (sFlt-1) as an anti-angiogenic factor were studied, the ratio of sFlt-1/PLGF (coefficient K) was calculated. All patients had Doppler examination of vascular blood flow in the left and right uterine arteries (pulsation index – PI, resistance index – RI and systolic-diastolic ratio – SDR). The ultrasound examination was done with the ultrasound machine “Mylab Six System”. Statistical analysis was performed using program Statistica® for Windows 13.0. A single-factor logistic regression analysis and a method of building logistics regression, which was evaluated by means of receive operating characteristic curve (ROC-curve) according to the area under the curve (AUC) were used to determine the prognostic level of markers, the 95 % confidence interval was calculated. Results. In the first trimester of pregnancy in women with CAH the PLGF level was < 8.2 pg/ml (sensitivity – 80.0 %, specificity – 60.78 %), area under the ROC curve (AUC) – 0.697 (95 % CI: 0.566–0.808; p =0.0128), which indicate an increased risk of FGR development. The growth of sFl-1 > 1802.59 ng/ml (sensitivity – 70.0 %, specificity – 64.71 %), area under the ROC-curve (AUC) 0.678 (95 % CI: 0.547–0.792; p=0.05) increase the risk of FGR development. The coefficient K in 11-12 weeks of pregnancy was ≥ 95.36 units (sensitivity – 100.0 %, specificity – 43.14 %), area under ROC-curve (AUC) – 0.735 (95 % CI: 0.607–0.840; p=0.0128), which indicate an increase the risk of FGR development. PG/PlGF ratio is 7.21 (sensitivity – 70.0 %, specificity – 70.59 %) and area under the ROC-curve (AUC) 0.702 (95 % CI: 0.571–0.812; p = 0.0118) also indicate the increase the risk of FGR development, as well as the value of the ratio of E/PLGF > 138.53 (sensitivity – 100.0 %, specificity – 35.29 %) and area under the ROC-curve (AUC) 0.640 (95 % CI: 0.507– 0,759). Doppler results in pregnant women with CAH, in the presence of risk factors for FGR development, demonstrate that the CDR was not likely to differ in all groups of patients: 3.62±0.09 units in the persons with CAH and FGR (n=10) and 3.71±0.05 units in the pregnant women with CAG without FGR (n=51) in the right uterine artery; 3.63 ± 0.09 units and 3.71 ± 0.05 units in the left uterine artery, respectively (p<0.05 for all values). However, if PI in the right uterine artery is more than 1.84 units and more than 1.82 units in the left uterine artery, the FGR will further develop. Conclusions. According to the results of the study, it was found that pregnant women with CAH 1-2th degrees with FGR development in the future, in the first trimester of gestation (11-12 weeks) have a decrease PlGF level, sFlt-1and the coefficient K increase. These indicators in the 11–12 weeks of pregnancy were: PlGF ≤ 8.2 pg/ml, sFlt-1 > 1802.59 ng/ml, coefficient K ≥ 95.36 units, and PG/PlGF > 7.21 units, E/PlGF > 138.53 units and CHG/PlGF ≥ 30.14 units.In the pregnant women with CAG, in whom FGR risk will subsequently determine, the significant changes in the CDR and RI at 11-12 weeks of pregnancy are not established, but with an increase of PI more than 1.84 units in the right uterine artery and more than 1.82 units in the left uterine artery FGR will further develop.

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“…Screening for abnormal fetal growth is a prerequisite for its timely detection, and enables intensified surveillance (e.g. Doppler studies) for fetal distress and optimization of timing of delivery [3][4][5] . To classify fetuses at risk, small-for-gestational-age (SGA) is often used as a proxy for FGR 1,6 .…”

Section: Introductionmentioning

confidence: 99%

Implication of third‐trimester screening accuracy for small‐for‐gestational age and additive value of third‐trimester growth‐trajectory indicators in predicting severe adverse perinatal outcome in low‐risk population: pragmatic secondary analysis of IRIS study

Roekel

Henrichs

Franx

et al. 2023

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?This study showed that false-positive small-forgestational-age screening findings do not necessarily lead to increased obstetric intervention. We found no evidence that using the third-trimester growth-trajectory measurements abdominal circumference crossing > 20 or > 50 centiles or estimated fetal weight crossing > 20 centiles is of additive value in identifying fetuses at risk of severe adverse perinatal outcome in a low-risk population. In addition, we found no convincing evidence that abdominal circumference growth velocity < 10% is of additive value in identifying fetuses at risk of severe adverse perinatal outcome. What is the clinical implications of this work?Obstetric-care professionals should be aware that using third-trimester growth-trajectory measurements for identification of abnormal fetal growth is not beneficial in populations remaining at low risk throughout pregnancy.

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Evaluation and Management of Suspected Fetal Growth Restriction

Cited by 10 publications

References 64 publications

Intrauterine exposure to maternal opioid maintenance treatment and associated risk factors may impair child growth

Intrauterine exposure to maternal opioid maintenance treatment and associated risk factors may impair child growth

Prediction of the development of fetal growth retardation in pregnant women with chronic arterial hypertension

Implication of third‐trimester screening accuracy for small‐for‐gestational age and additive value of third‐trimester growth‐trajectory indicators in predicting severe adverse perinatal outcome in low‐risk population: pragmatic secondary analysis of IRIS study

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