scholarly journals Fetal growth velocity references from a Chinese population–based fetal growth study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tianchen Wu ◽  
Xiaoli Gong ◽  
Yangyu Zhao ◽  
Lizhen Zhang ◽  
Yiping You ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Growth Velocity ◽  
Chinese Population ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Fetal Ultrasound ◽  
Ultrasound Measurements ◽  
Appropriate For Gestational Age ◽  
Adverse Perinatal Outcomes

Abstract Background Fetal growth velocity standards have yet to be established for the Chinese population. This study aimed to establish such standards suitable for the Chinese population. Methods We performed a multicenter, population–based longitudinal cohort study including 9075 low–risk singleton pregnant women. Data were collected from the clinical records of 24 hospitals in 18 provinces of China. Demographic characteristics, reproductive history, fetal ultrasound measurements, and perinatal outcome data were collected. The fetal ultrasound measurements included biparietal diameter (BPD), abdominal circumference (AC), head circumference (HC), and femur diaphysis length (FDL). We used linear mixed models with cubic splines to model the trajectory of four ultrasound parameters and estimate fetal weight. Fetal growth velocity was determined by calculating the first derivative of fetal size curves. We also used logistic regression to estimate the association between fetal growth velocities in the bottom 10th percentile and adverse perinatal outcomes. Results Fetal growth velocity was not consistent over time or among individuals. The estimated fetal weight (EFW) steadily increased beginning at 12 gestational weeks and peaked at 35 gestational weeks. The maximum velocity was 211.71 g/week, and there was a steady decrease in velocity from 35 to 40 gestational weeks. The four ultrasound measurements increased in the early second trimester; BPD and HC peaked at 13 gestational weeks, AC at 14 gestational weeks, and FDL at 15 gestational weeks. BPD and HC also increased from 19 to 24 and 19 to 21 gestational weeks, respectively. EFW velocity in the bottom 10th percentile indicated higher risks of neonatal complications (odds ratio [OR] = 2.23, 95% confidence interval [CI]: 1.79–2.78) and preterm birth < 37 weeks (OR = 3.68, 95% CI: 2.64–5.14). Sensitivity analyses showed that EFW velocity in the bottom 10th percentile was significantly associated with more adverse pregnancy outcomes for appropriate–for–gestational age neonates. Conclusions We established fetal growth velocity curves for the Chinese population based on real–world clinical data. Our findings demonstrated that Chinese fetal growth patterns are somewhat different from those of other populations. Fetal growth velocity could provide more information to understand the risk of adverse perinatal outcomes, especially for appropriate–for–gestational age neonates.

scholarly journals Perinatal Adverse Effects in Newborns with Estimated Loss of Weight Percentile between the Third Trimester Ultrasound and Delivery. The GROWIN Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4643
Author(s):  
María Sonsoles Galán Arévalo ◽  
Ignacio Mahillo-Fernández ◽  
Luis Mariano Esteban ◽  
Mercedes Andeyro-García ◽  
Roi Piñeiro Pérez ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Late Gestation ◽  
Third Trimester ◽  
Loss Of Weight ◽  
Increased Risk ◽  
Appropriate For Gestational Age ◽  
Adverse Perinatal Outcomes ◽  
Weight Percentile

Fetal growth restriction has been associated with an increased risk of adverse perinatal outcomes (APOs). We determined the importance of fetal growth detention (FGD) in late gestation for the occurrence of APOs in small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns. For this purpose, we analyzed a retrospective cohort study of 1067 singleton pregnancies. The newborns with higher APOs were SGA non-FGD and SGA FGD in 40.9% and 31.5% of cases, respectively, and we found an association between SGA non-FGD and any APO (OR 2.61; 95% CI: 1.35–4.99; p = 0.004). We did not find an increased APO risk in AGA FGD newborns (OR: 1.13, 95% CI: 0.80, 1.59; p = 0.483), except for cesarean delivery for non-reassuring fetal status (NRFS) with a decrease in percentile cutoff greater than 40 (RR: 2.41, 95% CI: 1.11–5.21) and 50 (RR: 2.93, 95% CI: 1.14–7.54). Conclusions: Newborns with the highest probability of APOs are SGA non-FGDs. AGA FGD newborns do not have a higher incidence of APOs than AGA non-FGDs, although with falls in percentile cutoff over 40, they have an increased risk of cesarean section due to NRFS. Further studies are warranted to detect these newborns who would benefit from close surveillance in late gestation and at delivery.

scholarly journals Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Na Zeng ◽  
Erica Erwin ◽  
Wendy Wen ◽  
Daniel J. Corsi ◽  
Shi Wu Wen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Adverse Perinatal Outcomes

Abstract Background Racial disparities in adverse perinatal outcomes have been studied in other countries, but little has been done for the Canadian population. In this study, we sought to examine the disparities in adverse perinatal outcomes between Asians and Caucasians in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Asian and Caucasian women who attended a prenatal screening and resulted in a singleton birth in an Ontario hospital (April 1st, 2015-March 31st, 2017). Generalized estimating equation models were used to estimate the independent adjusted relative risks and adjusted risk difference of adverse perinatal outcomes for Asians compared with Caucasians. Results Among 237,293 eligible women, 31% were Asian and 69% were Caucasian. Asians were at an increased risk of gestational diabetes mellitus, placental previa, early preterm birth (< 32 weeks), preterm birth, emergency cesarean section, 3rd and 4th degree perineal tears, low birth weight (< 2500 g, < 1500 g), small-for-gestational-age (<10th percentile, <3rd percentile), neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment, but had lower risks of preeclampsia, macrosomia (birth weight > 4000 g), large-for-gestational-age neonates, 5-min Apgar score < 7, and arterial cord pH ≤7.1, as compared with Caucasians. No difference in risk of elective cesarean section was observed between Asians and Caucasians. Conclusion There are significant differences in several adverse perinatal outcomes between Asians and Caucasians. These differences should be taken into consideration for clinical practices due to the large Asian population in Canada.

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

2019 ◽  
Vol 41 (12) ◽  
pp. 688-696
Author(s):  
Quênya Antunes Silveira Inácio ◽  
Edward Araujo Júnior ◽  
Luciano Marcondes Machado Nardozza ◽  
Caetano Galvão Petrini ◽  
Victor Paranaíba Campos ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Fetal Growth ◽  
Gestational Age ◽  
Late Onset ◽  
Neonatal Resuscitation ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Adverse Perinatal Outcomes ◽  
Gestational Age At Birth ◽  
Age At Birth

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.

scholarly journals Adjusting growth standards for fetal sex improves correlation of small babies with stillbirth and adverse perinatal outcomes: A state-wide population study

2021 ◽  
Author(s):  
Natasha Pritchard ◽  
Susan Walker ◽  
Stephen Tong ◽  
Anthea C. Lindquist
Keyword(s):  
Gestational Age ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Fetal Sex ◽  
Growth Standards ◽  
Increased Risk ◽  
Appropriate For Gestational Age ◽  
Adverse Perinatal Outcomes ◽  
Wide Population ◽  
High Risk Cohort

Objective: Identify the proportion of infants reclassified if sex-specific birthweight charts were used, and if this reclassification has an impact on the correlation between birthweight centile and adverse perinatal outcome. Design: Retrospective cohort study Setting: Victoria, Australia. Population: All infants born from 2005-2015 (529,261) Methods: We applied GROW centiles, either adjusted or unadjusted for fetal sex. We compared proportions of small for gestational age (SGA, <10th centile) infants, then the populations of males considered small only by sex-specific charts and females considered small only by unadjusted charts. Main Outcome Measures: Stillbirth, combined perinatal mortality, NICU admissions, Apgars <7 at 5 minutes, emergency caesarean sections. Results: Of those <10th centile by unadjusted charts, 39.6% were male, and 60.5% female. Using sex-specific charts, 50.3% <10th centile were male and 49.7% female. 9,449 (19.2%) females that were SGA according to unadjusted charts were appropriate for gestational age (AGA,>10th-<90th centile) using sex-specific charts. These reclassified newborn females were not at increased risk of adverse outcomes compared with an AGA infant, but were at increased risk of being iatrogenically delivered for suspected growth restriction (RR 4.90, 95%CI 4.39–5.48). 8,048 male infants were reclassified as SGA by sex-specific charts (25% SGA increase). Compared with AGA infants, these reclassified male newborns were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90) and all other adverse perinatal outcomes. Conclusions: Sex-specific growth standards classify a new high-risk cohort of male infants as SGA, and exclude a cohort of females, whose risk is no greater than appropriately grown infants.

Timing of Delivery in Pregnancies Complicated by Suspected Fetal Growth Restriction without Doppler Abnormalities

2019 ◽  
Vol 37 (06) ◽  
pp. 647-651
Author(s):  
Beth L. Pineles ◽  
Sarah Crimmins ◽  
Ozhan Turan
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Fetal Growth Restriction ◽  
Primary Outcome ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Abdominal Circumference ◽  
Fetal Ultrasound ◽  
Mortality And Morbidity ◽  
Increased Risk

Abstract Objective This study aimed to identify the optimal gestational age for delivery of pregnancies complicated by fetal growth restriction (FGR) without Doppler abnormalities. Study Design Cases of FGR (ultrasound-estimated fetal weight less than the 10th or abdominal circumference less than the 5th percentile for gestational age) without fetal Doppler abnormalities were identified from a fetal ultrasound database. The primary outcome was a composite of perinatal mortality and morbidity. The risk of the primary outcome for each gestational age was compared with pregnancies delivered at 390/7 to 406/7 weeks. Odds ratios were adjusted for potential confounders. Results The analysis included 1,024 pregnancies. FGR was identified at a median of 235/7 weeks (range: 20–42 weeks). Four cases of fetal death (234/7—376/7 weeks) and no neonatal deaths were included. The primary outcome occurred in 209 patients (20.4%). This was greater for patients delivered at less than 37 weeks' gestation than for those delivered at or after 39 weeks' gestation, with no increased risk after 40 weeks. Conclusion Among pregnancies complicated by suspected FGR without Doppler abnormalities, delivery at 39 weeks is safe with no difference in perinatal outcomes from 37 to 42 weeks.

scholarly journals Fetal growth standards for Chinese twin pregnancies

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jianping Chen ◽  
Jun Zhang ◽  
Yang Liu ◽  
Xing Wei ◽  
Yingjun Yang ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Perinatal Outcomes ◽  
Growth Charts ◽  
Growth Standards ◽  
Growth Standard ◽  
Adverse Perinatal Outcomes ◽  
Chinese Twins ◽  
Twin Pregnancies

Abstract Background The common use of singleton fetal growth standard to access twin growth might lead to over-monitoring and treatment. We aimed to develop fetal growth standards for Chinese twins based on ultrasound measurements, and compare it with Zhang’s and other twin fetal growth charts. Methods A cohort of uncomplicated twin pregnancies were prospectively followed in 2014–2017. Smoothed estimates of fetal growth percentiles for both monochorionic (MC) and dichorionic (DC) twins were obtained using a linear mixed model. We also created growth charts for twins using a model-based approach proposed by Zhang et al. Our twin standards were compared with Hadlock’s (singleton) in predicting adverse perinatal outcomes. Results A total of 398 twin pregnancies were included, with 214 MC and 582 DC live-born twins. The MC twins were slightly lighter than the DC twins, with small differences throughout the gestation. Our ultrasound-based fetal weight standards were comparable to that using Zhang’s method. Compared with previous references/standards from the US, Brazil, Italy and UK, our twins had very similar 50th percentiles, but narrower ranges between the 5th and 95th or 10th and 90th percentiles. Compared with the Hadlock’s standard, the risks of neonatal death and adverse perinatal outcomes for small for gestational age (SGA) versus non-SGA were substantially elevated using our standards. Conclusions A normal fetal growth standard for Chinese twins was created. The differences between MC and DC twins were clinically insignificant. The 50th weight percentiles of the Chinese twins were identical to those in other races/ethnicities but the ranges were markedly narrower. Our standard performed much better than the Hadlock’s in predicting low birth weight infants associated with adverse perinatal outcomes in twin pregnancies. The present study also indicated that Zhang’s method is applicable to Chinese twins, and other areas may use Zhang’s method to generate their own curves for twins if deemed necessary.

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