Prenatal intrauterine growth restriction and risk of retinopathy of prematurity

Abstract

Low birthweight and decreased postnatal weight gain are known predictors of worse retinopathy of prematurity (ROP) but the role of prenatal growth patterns in ROP remains inconclusive. To distinguish small for gestational age (SGA) from intrauterine growth restriction (IUGR) as independent predictors of ROP, we performed a retrospective cohort study of patients who received ROP screening examinations at a level IV neonatal intensive care unit over a 7-year period. Data on IUGR and SGA status, worst stage of and need for treatment for ROP, and postnatal growth was obtained. 343 infants were included for analysis (mean gestational age = 28.6 weeks and birth weight = 1138.2 g). IUGR infants were more likely to have a worse stage of ROP and treatment-requiring ROP (both p < 0.0001) compared to non-IUGR infants. IUGR infants were more likely to be older at worst stage of ROP (p < 0.0001) and to develop postnatal growth failure (p = 0.01) than non-IUGR infants. Independent of postnatal growth failure status, IUGR infants had a 4–5 × increased risk of needing ROP treatment (p < 0.001) compared to non-IUGR infants. SGA versus appropriate for gestational age infants did not demonstrate differences in retinopathy outcomes, age at worst ROP stage, or postnatal growth failure. These findings emphasize the importance of prenatal growth on ROP development.

Role of maternal, fetal and placental histopathology factors in the pathogenesis of retinopathy of prematurity

“…In the present study we have found a strong association of fetal growth retardation with ROP disease. In literature, it has been found that the infants that have prenatal intrauterine growth retardation are at increased risk of developing severe ROP (Chu et al, 2020) Besides the placental size we have also found significant association of vascular changes at the maternal-fetal interface: distal villous hypoplasia, thin elongated villi, Tenny Parker changes, alternating area of small and short hyper mature villi with the disease. Along with these placental changes we have also found rare pathological changes in the placentas from the deliveries where infants developed ROP.…”

“…In the present study we have found a strong association of fetal growth retardation with ROP disease. In literature, it has been found that the infants that have prenatal intrauterine growth retardation are at increased risk of developing severe ROP (Chu et al ., 2020)…”

Time to regain birth weight - a marker to predict the severity of retinopathy of prematurity?

“…Studies have found inconsistent results for SGA being a risk factor for severe ROP. Filho et al [26] and Chu et al [37] found SGA not to be a risk factor for severe ROP, while Allegaert et al [28] reported SGA to be a risk factor for developing threshold ROP. However, a recent systematic review and meta-analysis found SGA to be associated with increased odds for severe ROP and suggested SGA to be considered in risk assessment of ROP evaluation [38].…”

Hematologic Risk Factors for the Development of Retinopathy of Prematurity—A Retrospective Study

“…Indeed, IUGR is a known factor for ROP, and a recent study retrospective cohort study by Chu et al demonstrated that IUGR infants were more likely to have a worse stage of ROP and treatment-requiring ROP compared to non-IUGR infants [ 26 ]. Additionally, it was demonstrated that a low 5-min Apgar score and an Apgar score of 6 or less at 5 min were significant risk factors for the manifested ROP to progress to stages requiring treatment [ 27 ].…”