1070 Neonatal outcomes in patients with resolved versus persistent uncomplicated fetal growth restriction

Abstract

When fetal growth restriction (FGR) resolves prior to delivery, antenatal testing is discontinued. The objective of this study was to evaluate if FGR that resolves confers a similar risk of neonatal morbidity compared to persistent uncomplicated FGR. This is a secondary analysis of a large, NIH-funded medical record abstraction study of singleton pregnancies delivered at a tertiary care center between 2002 and 2013. Women with either persistent or resolved FGR who delivered at 38 weeks or more were included. FGR was defined as persistent estimated fetal weight (EFW) < 10%ile. Resolved FGR was defined as EFW < 10%ile on at least one ultrasound (US), but EFW > 10%ile at last US prior to delivery. Women with abnormal umbilical artery Doppler studies were excluded. The primary outcome was a composite of neonatal morbidity: NICU admission, Apgar < 7 at 5 minutes, neonatal resuscitation, cord pH < 7.1, RDS, TTN, hypoglycemia, sepsis or death. Secondary outcomes were individual items in the composite. Baseline characteristics, obstetric and neonatal outcomes were compared using Wilcoxon rank-sum and Fisher’s exact test. Logistic regression was used to adjust for confounders. Of 777 women studied, 686 (88%) had persistent FGR and 91 (12%) had resolved FGR. Women with resolved FGR were more likely to have higher body mass index, gestational diabetes, preexisting diabetes, diagnosed with FGR earlier, had spontaneous labor and delivered at later gestational ages. There was no difference in the composite neonatal outcome (RR 1.03, 95% CI, 0.72, 1.47) for resolved versus persistent FGR even when adjusting for confounders (aRR 0.79, 95% CI 0.54, 1.17). There were no differences in cesarean delivery or delivery complications between groups. Though women with resolved FGR are managed differently than those with persistent FGR, resolved FGR fetuses do not have improved composite morbidity immediately after delivery compared to those where FGR persists. Future research is needed to determine whether additional surveillance results in improved outcomes in fetuses with resolved FGR.View Large Image Figure ViewerDownload Hi-res image Download (PPT)