Early‐ and late‐onset selective fetal growth restriction in monochorionic diamniotic twin pregnancy: natural history and diagnostic criteria

This study aims to evaluate the natural history, disease progression, and outcomes in dichorionic twins with selective fetal growth restriction (sFGR) according to different diagnostic criteria and time of onset. Dichorionic twins seen from the first trimester were included. sFGR was classified according to the Delphi consensus, and was compared to the outcomes of those classified by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) diagnostic criteria. Early sFGR occurred before 32-weeks, and late sFGR after 32-weeks. Disease progression, neonatal outcomes such as gestation at delivery, birthweight, neonatal unit (NNU) admission, and morbidities were compared. One-hundred twenty-three of 1053 dichorionic twins had sFGR, where 8.4% were classified as early sFGR, and 3.3% were late sFGR. Disease progression was seen in 36%, with a longer progression time (5 vs. 1 week) and higher progression rate (40% vs. 26%) in early sFGR. Perinatal death was significantly higher in the sFGR than the non-sFGR group (24 vs. 16 per 1000 births, p = 0.018), and those with early sFGR had more NNU admissions than late sFGR (p = 0.005). The ISUOG diagnostic criteria yielded a higher number of sFGR than the Delphi criteria, but similar outcomes. sFGR have worse perinatal outcomes, with early onset being more prevalent. Use of the Delphi diagnostic criteria can reduce over-diagnosis of sFGR and avoid unnecessary intervention.

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Early- and late-onset selective fetal growth restriction in monochorionic twin pregnancy with expectant management

Journal of Gynecology Obstetrics and Human Reproduction ◽

10.1016/j.jogoh.2022.102314 ◽

2022 ◽

pp. 102314

Author(s):

Ying Wang ◽

Huifeng Shi ◽

Xueju Wang ◽

Pengbo Yuan ◽

Yuan Wei ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Twin Pregnancy ◽

Late Onset ◽

Expectant Management ◽

Growth Restriction ◽

Monochorionic Twin

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Risk stratification for early-onset fetal growth restriction in women with abnormal serum biomarkers: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-020-78631-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

L. Ormesher ◽

L. Warrander ◽

Y. Liu ◽

S. Thomas ◽

L. Simcox ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Early Onset ◽

Late Onset ◽

Area Under The Curve ◽

Maternal Serum ◽

Serum Biomarkers ◽

Growth Restriction ◽

Aneuploidy Screening ◽

Internal Validation

AbstractAbnormal maternal serum biomarkers (AMSB), identified through the aneuploidy screening programme, are frequent incidental findings in pregnancy. They are associated with fetal growth restriction (FGR), but previous studies have not examined whether this association is with early-onset (< 34 weeks) or late-onset (> 34 weeks) FGR; as a result there is no consensus on management. The aims of this study were to determine the prevalence and phenotype of FGR in women with AMSB and test the predictive value of placental sonographic screening to predict early-onset FGR. 1196 pregnant women with AMSB underwent a 21–24 week “placental screen” comprising fetal and placental size, and uterine artery Doppler. Multivariable regression was used to calculate a predictive model for early-onset FGR (birthweight centile < 3rd/< 10th with absent umbilical end-diastolic flow, < 34 weeks). FGR prevalence was high (10.3%), however early-onset FGR was uncommon (2.3%). Placental screening effectively identified early-onset (area under the curve (AUC) 0.93, 95% confidence interval (CI) 0.87–1.00), but not late-onset FGR (AUC 0.70, 95% CI 0.64–0.75). Internal validation demonstrated robust performance for detection/exclusion of early-onset FGR. In this cohort, utilisation of our proposed algorithm with targeted fetal growth and Doppler surveillance, compared with universal comprehensive surveillance would have avoided 1044 scans, potentiating significant cost-saving for maternity services.

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Physiopathology of late-onset fetal growth restriction

Minerva Obstetrics and Gynecology ◽

10.23736/s2724-606x.21.04771-7 ◽

2021 ◽

Vol 73 (4) ◽

Author(s):

Edward ARAUJO JÚNIOR ◽

Ana C. ZAMARIAN ◽

Ana C. CAETANO ◽

Alberto B. PEIXOTO ◽

Luciano M. NARDOZZA

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Late Onset ◽

Growth Restriction

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miR-16-5p, miR-103-3p, and miR-27b-3p as Early Peripheral Biomarkers of Fetal Growth Restriction

Frontiers in Pediatrics ◽

10.3389/fped.2021.611112 ◽

2021 ◽

Vol 9 ◽

Author(s):

Salvatore Tagliaferri ◽

Pasquale Cepparulo ◽

Antonio Vinciguerra ◽

Marta Campanile ◽

Giuseppina Esposito ◽

...

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Fetal Growth Restriction ◽

Late Onset ◽

Maternal Blood ◽

Growth Restriction ◽

Therapeutic Interventions ◽

Control Group ◽

Fetal Hypoxia ◽

Blood Samples

Current tests available to diagnose fetal hypoxia in-utero lack sensitivity thus failing to identify many fetuses at risk. Emerging evidence suggests that microRNAs derived from the placenta circulate in the maternal blood during pregnancy and may be used as non-invasive biomarkers for pregnancy complications. With the intent to identify putative markers of fetal growth restriction (FGR) and new therapeutic druggable targets, we examined, in maternal blood samples, the expression of a group of microRNAs, known to be regulated by hypoxia. The expression of microRNAs was evaluated in maternal plasma samples collected from (1) women carrying a preterm FGR fetus (FGR group) or (2) women with an appropriately grown fetus matched at the same gestational age (Control group). To discriminate between early- and late-onset FGR, the study population was divided into two subgroups according to the gestational age at delivery. Four microRNAs were identified as possible candidates for the diagnosis of FGR: miR-16-5p, miR-103-3p, miR-107-3p, and miR-27b-3p. All four selected miRNAs, measured by RT-PCR, resulted upregulated in FGR blood samples before the 32nd week of gestation. By contrast, miRNA103-3p and miRNA107-3p, analyzed between the 32nd and 37th week of gestation, showed lower expression in the FGR group compared to aged matched controls. Our results showed that measurement of miRNAs in maternal blood may form the basis for a future diagnostic test to determine the degree of fetal hypoxia in FGR, thus allowing the start of appropriate therapeutic interventions to alleviate the burden of this disease.

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