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Am J Perinatol 2014; 31(03): 187-194
DOI: 10.1055/s-0033-1343771
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prenatal Detection of Fetal Growth Restriction in Newborns Classified as Small for Gestational Age: Correlates and Risk of Neonatal Morbidity

Suneet P. Chauhan
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Hind Beydoun
2   Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, Virginia
,
Eugene Chang
3   Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
,
Adam T. Sandlin
4   Department of Obstetrics and Gynecology, University of Arkansas, Little Rock, Arkansas
,
Josh D. Dahlke
5   Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
Elena Igwe
6   Department of Obstetrics and Gynecology, Temple University, Philadelphia, Pennsylvania
,
Everett F. Magann
4   Department of Obstetrics and Gynecology, University of Arkansas, Little Rock, Arkansas
,
Kristi R. Anderson
7   Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, Virginia
,
Alfred Z. Abuhamad
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Cande V. Ananth
8   Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York
9   Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York
› Author Affiliations
Further Information

Publication History

10 January 2013

06 March 2013

Publication Date:
16 April 2013 (online)

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Abstract

We examined the rate of detecting small for gestational age (SGA; birth weight < 10%) as intrauterine growth restriction (IUGR) prenatally at four centers and determined risks of composite neonatal morbidity (CNM) and mortality among detected versus undetected (no antenatal diagnosis of IUGR). A multicenter cohort study of 11,487 nonanomalous, singleton live births with sonographic exam before 22 weeks was performed. Of 11,487 births, 8% (n = 929) were SGA that met the inclusion criteria, with 25% of them being prenatally detected. The CNM among SGA births that were prenatally detected as IUGR was higher (23.3%) than undetected SGA (9.7%), but this difference was no longer significant following adjustments for confounding factors. Among preterm births (< 37 weeks), undetected SGA had significantly higher CNM (risk ratio [RR] 10.0, 95% confidence interval [CI] 6.3, 16.1) for deliveries at 24 to 33 weeks and RR 3.0, 95% CI 1.7, 5.4 for 34 to 36 weeks). In summary, only a quarter of SGA births were detected prenatally as IUGR and among preterm SGA, the CNM is significantly higher when SGA births are undetected as IUGR.

Keywords

small for gestational age - intrauterine growth restriction - composite neonatal morbidity - estimated fetal weight

Presentation Information

Presented at Society of Maternal-Fetal Medicine, Dallas, Texas, United States, February 6 to 11, 2012.


 

  • References

  • 1 American College of Obstetricians and Gynecologists. Intrauterine growth restriction. ACOG practice bulletin no. 12. Washington, DC: American College of Obstetricians and Gynecologists; 2000. , reaffirmed 2010
    Google Scholar
  • 2 de Onis M, Blössner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J Clin Nutr 1998; 52 (Suppl. 01) S5-S15
    PubMedGoogle Scholar
  • 3 Chen HY, Chauhan SP, Ward TC, Mori N, Gass ET, Cisler RA. Aberrant fetal growth and early, late, and postneonatal mortality: an analysis of Milwaukee births, 1996–2007. Am J Obstet Gynecol 2011; 204: e1 , e10
    PubMedGoogle Scholar
  • 4 Garite TJ, Clark R, Thorp JA. Intrauterine growth restriction increases morbidity and mortality among premature neonates. Am J Obstet Gynecol 2004; 191: 481-487
    CrossrefPubMedGoogle Scholar
  • 5 Imdad A, Yakoob MY, Siddiqui S, Bhutta ZA. Screening and triage of intrauterine growth restriction (IUGR) in general population and high risk pregnancies: a systematic review with a focus on reduction of IUGR related stillbirths. BMC Public Health 2011; 11 (Suppl. 03) S1
    PubMedGoogle Scholar
  • 6 Sun Y, Vestergaard M, Pedersen CB, Christensen J, Basso O, Olsen J. Gestational age, birth weight, intrauterine growth, and the risk of epilepsy. Am J Epidemiol 2008; 167: 262-270
    PubMedGoogle Scholar
  • 7 Mattioli KP, Sanderson M, Chauhan SP. Inadequate identification of small-for-gestational-age fetuses at an urban teaching hospital. Int J Gynaecol Obstet 2010; 109: 140-143
    CrossrefPubMedGoogle Scholar
  • 8 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87: 163-168
    CrossrefPubMedGoogle Scholar
  • 9 Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements—a prospective study. Am J Obstet Gynecol 1985; 151: 333-337
    CrossrefPubMedGoogle Scholar
  • 10 American College of Obstetricians and Gynecologists. Ultrasonography in pregnancy. ACOG practice bulletin no. 101. Washington, DC: American College of Obstetricians and Gynecologists; 2009
    Google Scholar
  • 11 American College of Obstetricians and Gynecologists. Diagnosis and management of preeclampsia and eclampsia. ACOG practice bulletin no. 33. Washington, DC: American College of Obstetricians and Gynecologists; 2002. , reaffirmed 2010
    Google Scholar
  • 12 American College of Obstetricians and Gynecologists. Chronic hypertension in pregnancy. ACOG practice bulletin no. 125. Washington, DC: American College of Obstetricians and Gynecologists; 2012
    Google Scholar
  • 13 American College of Obstetricians and Gynecologists. Premature rupture of membranes. ACOG practice bulletin no. 80. Washington, DC: American College of Obstetricians and Gynecologists; 2007
    Google Scholar
  • 14 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92: 529-534
    CrossrefPubMedGoogle Scholar
  • 15 Chauhan SP, Taylor M, Shields D, Parker D, Scardo JA, Magann EF. Intrauterine growth restriction and oligohydramnios among high-risk patients. Am J Perinatol 2007; 24: 215-221
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birth weight in relation to morbidity and mortality among newborn infants. N Engl J Med 1999; 340: 1234-1238
    CrossrefPubMedGoogle Scholar
  • 17 Chauhan SP, Gupta LM, Hendrix NW, Berghella V. American College of Obstetricians and Gynecologists. Intrauterine growth restriction: comparison of American College of Obstetricians and Gynecologists practice bulletin with other national guidelines. Am J Obstet Gynecol 2009; 200: e1-e6
    PubMedGoogle Scholar
  • 18 Berkley E, Chauhan SP, Abuhamad A. Society for Maternal-Fetal Medicine Publications Committee. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol 2012; 206: 300-308 ( Erratum in: Am J Obstet Gynecol 2012;206:508)
    CrossrefPubMedGoogle Scholar
  • 19 Espinoza J, Kusanovic JP, Kim CJ , et al. An episode of preterm labor is a risk factor for the birth of a small-for-gestational-age neonate. Am J Obstet Gynecol 2007; 196: e1-e5 , discussion e5–e6
    PubMedGoogle Scholar
  • 20 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371: 75-84
    CrossrefPubMedGoogle Scholar
  • 21 Carreno CA, Costantine MM, Holland MG, Ramin SM, Saade GR, Blackwell SC. Approximately one-third of medically indicated late preterm births are complicated by fetal growth restriction. Am J Obstet Gynecol 2011; 204: e1-e4
    PubMedGoogle Scholar
  • 22 Verlijsdonk JW, Winkens B, Boers K, Scherjon S, Roumen F. Suspected versus non-suspected small-for-gestational age fetuses at term: perinatal outcomes. J Matern Fetal Neonatal Med 2012; 25: 938-943
    CrossrefPubMedGoogle Scholar
  • 23 Wasiluk A, Mantur M, Kemona H, Szczepański M, Jasińska E, Milewski R. Thrombopoiesis in small for gestational age newborns. Platelets 2009; 20: 520-524
    CrossrefPubMedGoogle Scholar
  • 24 Mitsiakos G, Papaioannou G, Papadakis E , et al. Haemostatic profile of full-term, healthy, small for gestational age neonates. Thromb Res 2009; 124: 288-291
    CrossrefPubMedGoogle Scholar
  • 25 American College of Obstetricians and Gynecologists. Antepartum fetal surveillance. ACOG practice bulletin no. 9. Washington, DC: American College of Obstetricians and Gynecologists; 1999
    Google Scholar
  • 26 Evertson LR, Gauthier RJ, Collea JV. Fetal demise following negative contraction stress tests. Obstet Gynecol 1978; 51: 671-673
    PubMedGoogle Scholar
  • 27 Phelan JP. The nonstress test: a review of 3,000 tests. Am J Obstet Gynecol 1981; 139: 7-10
    PubMedGoogle Scholar
  • 28 Manning FA, Harman CR, Morrison I, Menticoglou SM, Lange IR, Johnson JM. Fetal assessment based on fetal biophysical profile scoring. IV. An analysis of perinatal morbidity and mortality. Am J Obstet Gynecol 1990; 162: 703-709
    CrossrefPubMedGoogle Scholar
  • 29 Kim SY, Khandelwal M, Gaughan JP, Agar MH, Reece EA. Is the intrapartum biophysical profile useful?. Obstet Gynecol 2003; 102: 471-476
    CrossrefPubMedGoogle Scholar
  • 30 Cosmi E, Ambrosini G, D'Antona D, Saccardi C, Mari G. Doppler, cardiotocography, and biophysical profile changes in growth-restricted fetuses. Obstet Gynecol 2005; 106: 1240-1245
    CrossrefPubMedGoogle Scholar
  • 31 Ananth CV, Vintzileos AM. Epidemiology of preterm birth and its clinical subtypes. J Matern Fetal Neonatal Med 2006; 19: 773-782
    CrossrefPubMedGoogle Scholar
  • 32 Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2006; (3) CD006066
    PubMedGoogle Scholar
  • 33 Chen HY, Chauhan SP, Ananth CV, Vintzileos AM, Abuhamad AZ. Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States. Am J Obstet Gynecol 2011; 204: e1-e10
    PubMedGoogle Scholar
  • 34 Werner EF, Savitz DA, Janevic TM , et al. Mode of delivery and neonatal outcomes in preterm, small-for-gestational-age newborns. Obstet Gynecol 2012; 120: 560-564
    CrossrefPubMedGoogle Scholar
  • 35 Humphries J, Reynolds D, Bell-Scarbrough L, Lynn N, Scardo JA, Chauhan SP. Sonographic estimate of birth weight: relative accuracy of sonographers versus maternal-fetal medicine specialists. J Matern Fetal Neonatal Med 2002; 11: 108-112
    PubMedGoogle Scholar
  • 36 Chauhan SP, Hendrix NW, Magann EF, Morrison JC, Scardo JA, Berghella V. A review of sonographic estimate of fetal weight: vagaries of accuracy. J Matern Fetal Neonatal Med 2005; 18: 211-220
    CrossrefPubMedGoogle Scholar
  • 37 Minior VK, Divon MY. Fetal growth restriction at term: myth or reality?. Obstet Gynecol 1998; 92: 57-60
    CrossrefPubMedGoogle Scholar