Abstract
To evaluate the association between early-onset fetal growth restriction (FGR), late-onset FGR, small for gestational age (SGA) and adequate for gestational age (AGA) fetuses and adverse perinatal outcomes. This was a retrospective longitudinal study in which 4 groups were evaluated: 1 - early-onset FGR (before 32 weeks) (n = 20), 2 - late-onset FGR (at or after 32 weeks) (n = 113), 3 - SGA (n = 59), 4 - AGA (n = 476). The Kaplan-Meier curve was used to compare the time from the diagnosis of FGR to birth. Logistic regression was used to determine the best predictors of adverse perinatal outcomes in fetuses with FGR and SGA. A longer time between the diagnosis and birth was observed for AGA than for late FGR fetuses (p < 0.001). The model including the type of FGR and the gestational age at birth was significant in predicting the risk of hospitalization in the neonatal intensive care unit (ICU) (p < 0.001). The model including only the type of FGR predicted the risk of needing neonatal resuscitation (p < 0.001), of respiratory distress (p < 0.001), and of birth at < 32, 34, and 37 weeks of gestation, respectively (p < 0.001). Fetal growth restriction and SGA were associated with adverse perinatal outcomes. The type of FGR at the moment of diagnosis was an independent variable to predict respiratory distress and the need for neonatal resuscitation. The model including both the type of FGR and the gestational age at birth predicted the risk of needing neonatal ICU hospitalization.
Highlights
Fetal growth restriction (FGR) is influenced by several factors and occurs in $ 7 to 15% of all gestations.[1,2,3,4] Within the same country, it can vary according to cultural and socioeconomic characteristics
We found that other adverse perinatal outcomes had a significant correlation between intrauterine growth impairment and adequate for gestational age (AGA) groups, like hypothermia and hypoglycemia
We have observed that the criteria established for FGR by the Delphi procedure were good predictors for adverse perinatal outcomes
Summary
Fetal growth restriction (FGR) is influenced by several factors and occurs in $ 7 to 15% of all gestations.[1,2,3,4] Within the same country, it can vary according to cultural and socioeconomic characteristics. The most common cause of FGR is a deficit in the transport of nutrients and oxygen to the fetus through the placenta, but several other maternal factors, such as poor socioeconomic and cultural condition, malnutrition, and chronic vascular disease, as well as fetal factors, such as genetic syndromes and infections, can be involved in this growth impairment.[1,2,3] The most widely adopted definition of FGR is an estimated fetal weight (EFW) below the 10th percentile for the gestational age.[1,2] some fetuses considered as having FGR do not present pathological growth features and are merely considered as small for gestational age (SGA).[1,2,3] Small for gestational age differs from FGR, because it includes the majority of constitutionally small, but healthy fetuses with lower risk of adverse perinatal outcome.[4]
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