Prediction of Late-Onset Small for Gestational Age and Fetal Growth Restriction by Fetal Biometry at 35 Weeks and Impact of Ultrasound-Delivery Interval: Comparison of Six Fetal Growth Standards.

Ricardo Savirón-Cornudella,Gerardo Sanz,Peña Dieste-Pérez,Luis Mariano Esteban,Berta Castán-Larraz,Rocío Aznar-Gimeno,Mauricio Tajada-Duaso,Faustino R Pérez-López,Jose Manuel Campillos

doi:10.3390/jcm10132984

Abstract

Small-for-gestational-age (SGA) infants have been associated with increased risk of adverse perinatal outcomes (APOs). In this work, we assess the predictive ability of the ultrasound-estimated percentile weight (EPW) at 35 weeks of gestational age to predict late-onset SGA and APOs, according to six growth standards, and whether the ultrasound–delivery interval influences the detection rate. To this purpose, we analyze a retrospective cohort study of 9585 singleton pregnancies. EPWs at 35 weeks were calculated to the customized Miguel Servet University Hospital (MSUH) and Figueras standards and the non-customized MSUH, Fetal Medicine Foundation (FMF), INTERGROWTH-21st, and WHO standards. As results of our analysis, for a 10% false positive rate, the detection rates for SGA ranged between 48.9% with the customized Figueras standard (AUC 0.82) and 60.8% with the non-customized FMF standard (AUC 0.87). Detection rates to predict SGA by ultrasound–delivery interval (1–6 weeks) show higher detection rates as intervals decrease. APOs detection rates ranged from 27.0% with FMF to 7.9% with the Figueras standard. In conclusion, the ability of EPW to predict SGA at 35 weeks is good for all standards, and slightly better for non-customized standards. The APO detection rate is significantly greater for non-customized standards.

Highlights

Screenings for fetal growth abnormalities are essential components of antenatal care, and fetal ultrasound plays a key role in the assessment of these conditions [1,2,3]
We assess the predictive ability of the ultrasound-estimated percentile weight (EPW) at 35 weeks of gestational age to predict late-onset SGA and adverse perinatal outcomes (APOs), according to six growth standards, and whether the ultrasound–delivery interval influences the detection rate
EPWs at 35 weeks were calculated to the customized Miguel Servet University Hospital (MSUH) and Figueras standards and the non-customized MSUH, Fetal Medicine Foundation (FMF), INTERGROWTH-21st, and World Health Organization (WHO) standards

Summary

Introduction

Screenings for fetal growth abnormalities are essential components of antenatal care, and fetal ultrasound plays a key role in the assessment of these conditions [1,2,3]. Smallfor-gestational-age (SGA) infants—those with a birth weight below the 10th percentile according to the standards [4]—have been associated with increased risk of adverse perinatal outcomes (APOs) [5]. These fetuses are the leading cause of stillbirth [6,7,8], and have more risks of both neonatal morbidity [9] and mortality [10,11]. The Royal College of Obstetricians and Gynecologists (RCOG) [25] recommends the use of customized birthweight curves to identify SGA fetuses; the adjustment of fetal weight should be performed individually, and not by population— some studies have questioned the superiority of the EPW by customized standards and its association with APOs [26,27], and SGA with APOs [28]

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