Reduced fetal growth velocities and the association with neonatal outcomes in appropriate-for-gestational-age neonates: a retrospective cohort study

Hendrix, M.; Kuijk, Sander M. J. van; Gavilanes, Antonio W. D.; Kramer, D.; Spaanderman, M.E.A.; Nasiry, S. Al

doi:10.1186/s12884-018-2167-5

Cited by 17 publications

(9 citation statements)

References 38 publications

(46 reference statements)

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“…We and others have demonstrated the added value of combining the measurement of placental biomarkers in the first trimester with clinical characteristics, Doppler parameters or fetal growth in the prediction of FGR. 38,43,44 The use of multiple parameters could increase the specificity and sensitivity of the screening, mainly because each biomarker reflect a different mechanistic pathway linked to the disease process. While abnormal uterine artery Doppler reflects the inadequate trophoblastic invasion of the maternal spiral arteries, abnormal serum concentrations of PlGF and sFlt-1 reflect the dysregulated secretory activity by placental trophoblasts, 6 both well recognized mechanisms linked to the development of FGR.…”

Section: Discussionmentioning

confidence: 99%

Role of sFlt-1 and PlGF in the screening of small-for-gestational age neonates during pregnancy: A systematic review

et al. 2019

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Background Fetal growth restriction, i.e. the restriction of genetically predetermined growth potential due to placental dysfunction, is a major cause of neonatal morbidity and mortality. The consequences of inadequate fetal growth can be life-long, but the risks can be reduced substantially if the condition is identified prenatally. Currently, screening strategies are based on ultrasound detection of a small-for-gestational age fetus and do not take into account the underlying vascular pathology in the placenta. Measurement of maternal circulating angiogenic biomarkers placental growth factor, sFlt-1 (soluble FMS-like tyrosine kinase-1) are increasingly used in studies on fetal growth restriction as they reflect the pathophysiological process in the placenta. However, interpretation of the role of angiogenic biomarkers in prediction of fetal growth restriction is hampered by the varying design, population, timing, assay technique and cut-off values used in these studies. Methods We conducted a systematic-review in PubMed (MEDLINE), EMBASE (Ovid) and Cochrane to explore the predictive performance of maternal concentrations of placental growth factor, sFlt-1 and their ratio for fetal growth restriction and small-for-gestational age, at different gestational ages, and describe the longitudinal changes in biomarker concentrations and optimal discriminatory cut-off values. Results We included 26 studies with 2514 cases with small-for-gestational age, 27 cases of fetal growth restriction, 582 cases mixed small-for-gestational age/fetal growth restriction and 29,374 reference. The largest mean differences for the two biomarkers and their ratio were found after 26 weeks of gestational age and not in the first trimester. The ROC-AUC varied between 0.60 and 0.89 with sensitivity and specificity matching the different cut-off values or a preset false-positive rate of 10%. Conclusions Most of the studies did not make a distinction between small-for-gestational age and fetal growth restriction, and therefore the small-for-gestational age group consists of fetuses with growth restriction and fetuses that are constitutionally normal. The biomarkers can be a valuable screening tool for small-for-gestational age pregnancies, but unfortunately, there is not yet a clear cut-off value to use for screening. More research is needed to see if these biomarkers are sufficiently able to differentiate growth restriction on their own and how these biomarkers in combination with other relevant clinical and ultrasound parameters can be used in clinical routine diagnostics.

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Section: Discussionmentioning

confidence: 99%

Role of sFlt-1 and PlGF in the screening of small-for-gestational age neonates during pregnancy: A systematic review

et al. 2019

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“…Moreover, sensitivity analysis showed that EFW velocity in the bottom 10th percentile was significantly associated with more adverse perinatal outcomes (including preterm birth < 37 weeks, admitted to NICU, neonatal complications) in the AGA group than the LGA and SGA groups. Hendrix et al [ 32 ] reported similar findings, i.e., decreased fetal growth velocities between around 20 and 32 weeks were significantly associated with adverse neonatal outcomes (neonatal asphyxia, sepsis, respiratory distress syndrome, and transient shortness of breath) in AGA neonates. In a prospective cohort of 3977 pregnant women, Sovio et al [ 33 ] found that, compared to EFW velocity alone in the bottom 10th percentile, AC velocity in the lowest decile was also associated with a higher relative risk of SGA and other adverse perinatal outcomes.…”

Section: Discussionmentioning

confidence: 77%

Fetal growth velocity references from a Chinese population–based fetal growth study

Gong

Zhao

et al. 2021

BMC Pregnancy Childbirth

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Background Fetal growth velocity standards have yet to be established for the Chinese population. This study aimed to establish such standards suitable for the Chinese population. Methods We performed a multicenter, population–based longitudinal cohort study including 9075 low–risk singleton pregnant women. Data were collected from the clinical records of 24 hospitals in 18 provinces of China. Demographic characteristics, reproductive history, fetal ultrasound measurements, and perinatal outcome data were collected. The fetal ultrasound measurements included biparietal diameter (BPD), abdominal circumference (AC), head circumference (HC), and femur diaphysis length (FDL). We used linear mixed models with cubic splines to model the trajectory of four ultrasound parameters and estimate fetal weight. Fetal growth velocity was determined by calculating the first derivative of fetal size curves. We also used logistic regression to estimate the association between fetal growth velocities in the bottom 10th percentile and adverse perinatal outcomes. Results Fetal growth velocity was not consistent over time or among individuals. The estimated fetal weight (EFW) steadily increased beginning at 12 gestational weeks and peaked at 35 gestational weeks. The maximum velocity was 211.71 g/week, and there was a steady decrease in velocity from 35 to 40 gestational weeks. The four ultrasound measurements increased in the early second trimester; BPD and HC peaked at 13 gestational weeks, AC at 14 gestational weeks, and FDL at 15 gestational weeks. BPD and HC also increased from 19 to 24 and 19 to 21 gestational weeks, respectively. EFW velocity in the bottom 10th percentile indicated higher risks of neonatal complications (odds ratio [OR] = 2.23, 95% confidence interval [CI]: 1.79–2.78) and preterm birth < 37 weeks (OR = 3.68, 95% CI: 2.64–5.14). Sensitivity analyses showed that EFW velocity in the bottom 10th percentile was significantly associated with more adverse pregnancy outcomes for appropriate–for–gestational age neonates. Conclusions We established fetal growth velocity curves for the Chinese population based on real–world clinical data. Our findings demonstrated that Chinese fetal growth patterns are somewhat different from those of other populations. Fetal growth velocity could provide more information to understand the risk of adverse perinatal outcomes, especially for appropriate–for–gestational age neonates.

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“…Hendrix et al evaluated infants in whom weight was appropriate for gestational age (AGA), defined as birthweight >10%ile and found that abnormal fetal growth velocities, especially abdominal circumference velocity, was associated with adverse neonatal outcomes. 22 This study concluded that using EFW < 10%ile alone in ultrasound evaluation may miss mild restriction of growth potential. Although limited studies have specifically compared neonatal outcomes in pregnancies complicated by fetal growth restriction versus those with transient fetal growth restriction, there have been studies…”

Section: Discussionmentioning

confidence: 83%

Outcomes among Neonates after a Diagnosis of Persistent or Transient Fetal Growth Restriction Delivered at Term

et al. 2023

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Objective To evaluate whether transient fetal growth restriction (FGR) that resolves prior to delivery confers a similar risk of neonatal morbidity as uncomplicated fetal growth restriction that persists at term. Study Design This is a secondary analysis of a medical record abstraction study of singleton live-born pregnancies delivered at a tertiary care center between 2002 and 2013. Pregnancies with either persistent or transient FGR who delivered at 38 weeks or later were included. Patients with abnormal umbilical artery Doppler studies were excluded. Persistent FGR was defined as estimated fetal weight (EFW) < 10%ile from diagnosis through delivery. Transient FGR was defined as EFW < 10%ile on at least one ultrasound, but not on the last ultrasound prior to delivery. The primary outcome was a composite of neonatal morbidity: Neonatal Intensive Care Unit admission, Apgar < 7 at 5 minutes, neonatal resuscitation, arterial cord pH < 7.1, Respiratory Distress Syndrome, Transient Tachypnea of the Newborn, hypoglycemia, sepsis or death. Baseline characteristics and obstetric and neonatal outcomes were compared using Wilcoxon rank-sum and Fisher’s exact test. Log binomial regression was used to adjust for confounders. Results Of 777 patients studied, 686 (88%) had persistent FGR and 91 (12%) had transient FGR. Patients with transient FGR were more likely to have a higher body mass index, gestational diabetes, diagnosed with FGR earlier in pregnancy, have spontaneous labor and deliver at later gestational ages. There was no difference in the composite neonatal outcome (RR 1.03, 95% CI, 0.72, 1.47) for transient versus persistent FGR after adjusting for confounders (aRR 0.79, 95% CI 0.54, 1.17). There were no differences in cesarean delivery or delivery complications between groups. Conclusion Neonates born at term after transient FGR do not appear to have differences in composite morbidity compared to those where uncomplicated fetal growth restriction persists at term.

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Reduced fetal growth velocities and the association with neonatal outcomes in appropriate-for-gestational-age neonates: a retrospective cohort study

Cited by 17 publications

References 38 publications

Role of sFlt-1 and PlGF in the screening of small-for-gestational age neonates during pregnancy: A systematic review

Role of sFlt-1 and PlGF in the screening of small-for-gestational age neonates during pregnancy: A systematic review

Fetal growth velocity references from a Chinese population–based fetal growth study

Outcomes among Neonates after a Diagnosis of Persistent or Transient Fetal Growth Restriction Delivered at Term

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