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CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(12): 688-696
DOI: 10.1055/s-0039-1697987
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Perinatal Outcomes of Fetuses with Early Growth Restriction, Late Growth Restriction, Small for Gestational Age, and Adequate for Gestational Age

Resultados perinatais de fetos com restrição de crescimento precoce, restrição de crescimento tardia, pequenos para a idade gestacional e adequados para a idade gestacional
Quênya Antunes Silveira Inácio
1   Universidade de Uberaba, Uberaba, MG, Brazil
,
Edward Araujo Júnior 
2   Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
3   Universidade Municipal de São Caetano do Sul, São Paulo, SP, Brazil
,
Luciano Marcondes Machado Nardozza
2   Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Caetano Galvão Petrini
1   Universidade de Uberaba, Uberaba, MG, Brazil
4   Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
,
Victor Paranaíba Campos
5   Faculdade de Tecnologia em Saúde, Ribeirão Preto, SP, Brazil
6   Universidade Barão de Mauá, Ribeirão Preto, SP, Brazil
,
Alberto Borges Peixoto
1   Universidade de Uberaba, Uberaba, MG, Brazil
4   Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
› Author Affiliations
Further Information

Publication History

15 March 2019

19 August 2019

Publication Date:
19 December 2019 (online)

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Abstract

Objective 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.

Methods 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.

Results 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).

Conclusion 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.

Resumo

Objetivo Avaliar o efeito da restrição de crescimento fetal (RCF) precoce, RCF tardio, fetos pequenos constitucionais para idade gestacional (PIG) e fetos adequados para idade gestacional (AIG) sobre resultados adversos perinatais.

Métodos Estudo longitudinal e retrospectivo, no qual foram avaliados quatro grupos: 1 — RCF precoce (< 32 semanas) (n = 20), 2 — RCF tardio (≥ 32 semanas) (n = 113), 3 — PIG (n = 59), 4 — AIG (n = 476). A curva de Kaplan-Meier foi utilizada para comparar o tempo entre o diagnóstico da RCF e o parto. Regressão logística foi utilizada para determinação dos melhores previsores de resultados perinatais adversos entre os fetos com RCF e PIG.

Resultados Os fetos AIGs apresentaram maior tempo entre o diagnóstico e parto, enquanto fetos RCF tardio apresentaram menor tempo (p < 0,001). O modelo contendo tanto os tipos de RCF quanto a idade gestacional no momento do parto foi significativo em predizer o risco de internação na unidade de terapia intensiva (UTI) neonatal (p < 0,001). O modelo incluindo apenas o tipo de FGR prediz o risco de ressuscitação neonatal (p < 0,001), de desconforto respiratório (p < 0,001) e de nascimento < 32, 34 e 37 semanas de gestação, respectivamente (p < 0,001).

Conclusão Os desvios do crescimento, RCF e PIG, foram associados a resultados perinatais adversos. O tipo de RCF no momento do diagnóstico foi variável independente para predizer necessidade de reanimação neonatal e desconforto respiratório. O modelo que incluiu o tipo de FGR e idade gestacional no nascimento prediz o risco de necessitar de internação em UTI neonatal.

Keywords

fetal growth restriction - small for gestational age - adverse perinatal outcomes

Palavras-chave

restrição do crescimento fetal - pequeno para a idade gestacional - resultados perinatais adversos

Contributors

All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.


 

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