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 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.

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 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 A Comparison of Prediction of Adverse Perinatal Outcomes between Hadlock and INTERGROWTH-21st Standards at the Third Trimester

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Chen Zhu ◽  
Yun-Yun Ren ◽  
Jiang-Nan Wu ◽  
Qiong-Jie Zhou
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Accuracy ◽  
Characteristic Curve ◽  
Perinatal Outcomes ◽  
Third Trimester ◽  
Clinical Value ◽  
Cutoff Value ◽  
The Third ◽  
Increased Risk ◽  
Adverse Perinatal Outcomes

Little is known about the clinical value of the Hadlock and INTERGROWTH-21st EFW standards for predicting adverse perinatal outcomes (APOs) in the third trimester. The purpose of this study was to study the association between low estimated fetal weight percentile (EFWc) in the third trimester and the risk of APOs and compare predictions of APOs between Hadlock and INTERGROWTH-21st EFW standards. A prospective cohort of 690 singleton pregnancies with ultrasonography performed in the third trimester between March 2015 and March 2016 in China was conducted. EFW and the corresponding EFWc were measured using the Hadlock and INTERGROWTH-21st standards, respectively. Cox proportional hazard models were used to assess the relationship between low EFWc (i.e., <5 percentile, P5) and the risk of APOs. Compared with fetuses with ≥P5 of the EFWc, fetuses with <P5 of the EFWc were much more likely to have an APO, with adjusted hazard ratios of 35.0 (95% confidence interval, 13.9-88.5) and 17.5 (7.7-39.6) for the Hadlock and INTERGROWTH standards, respectively. The Hadlock-EFWc had a higher predictive accuracy for APOs than the INTERGROWTH-EFWc, with area under the receiver operating characteristic curve of 0.94 (0.92-0.95) and 0.90 (0.87-0.92), respectively (P=0.007). The cutoff value for the INTERGROWTH-EFWc was percentile 11.61 with a sensitivity and specificity of 87.9% and 80.5%, respectively. For the Hadlock-EFWc, the corresponding sensitivity and specificity were 93.9% and 81.2%, with a cutoff value of percentile 8.65. Fetuses with low EFWc (i.e., <P5) were associated with an increased risk of APOs. APOs were more accurately predicted when EFWc was measured by the Hadlock standard than by the INTERGROWTH-21st standard.

Macrosomia in Infants of Insulin-Dependent Diabetic Mothers

PEDIATRICS ◽  
1989 ◽  
Vol 83 (6) ◽  
pp. 1029-1034
Author(s):  
Michael A. Berk ◽  
Francis Mimouni ◽  
Menachem Miodovnik ◽  
Vicki Hertzberg ◽  
Jennifer Valuck
Keyword(s):  
Glycemic Control ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Large For Gestational Age ◽  
Third Trimester ◽  
The Third ◽  
Appropriate For Gestational Age ◽  
Insulin Dependent ◽  
Insulin Dependent Diabetic ◽  
Diabetic Mothers

The purpose of the present study was to evaluate factors affecting the rate of macrosomia and related complications in a population of infants of insulin-dependent diabetic mothers. The following factors were hypothesized to be predisposing to macrosomia: increased maternal weight gain during gestation, increased number of births until infant No. 3, white race, increased maternal age, poor glycemic control from the 20th week of gestation, and increased insulin dose. Advance White classification and increased duration of diabetes were predicted to be inversely related. In addition, macrosomia was hypothesized to predispose to selected adverse perinatal outcomes including premature labor, birth asphyxia, birth injury, hypoglycemia, polycythemia, and respiratory distress syndrome. From 1978 to 1986, 127 pregnancies were prospectively studied, 86 of the total number of women were entered prior to 10 weeks' gestation, and 41 were entered after 10 weeks' gestation. Patients monitored blood glucose at least twice daily with glycemic control achieved by "split-dosage" regimens of insulin. Glycohemoglobin was measured monthly. Pregnancy dating was based on the date of the last menstrual period and the Ballard score of the infant at birth. Macrosomia was defined as a birth weight greater than the 90th percentile of the intrauterine growth curves of Lubchenco. Of the babies born to mothers with insulin-dependent diabetes, 43% were large for gestational age and 57% were appropriate for gestational age. Maternal factors predisposing to an infant being large for gestational age included glycohemoglobin measurement at the time of delivery (large for gestational age = 8.4% ± 0.3%, appropriate for gestational age = 7.6% ± 0.2%, P &lt; .05, normal = 5.5% to 8.5%), reflecting poorer glycemic control during the third trimester, weight gain in the third trimester, and advanced White classification by univariate analysis compared to mothers of babies with birth weights appropriate for gestational age. However, only glycohemoglobin at the time of delivery was significant when these variables were subjected to multiple logistical regression. Macrosomic infants had higher rates of both polycythemia (large for gestational age = 23.6%, appropriate for gestational age = 6.9%, P &lt; .008) and hyperbilirubinemia (large for gestational age = 29.6%, appropriate for gestational age = 12.7%, P &lt; .02) than nonmacrosomic infants but did not differ in other perinatal outcomes. The data suggest that, in spite of improvements in glycemic control in the recent past, macrosomia still exists at an increased rate in infants of diabetic mothers and is significantly related to poorer glycemic control in the third trimester. In addition, large for gestational age infants are at an increased risk for both polycythemia and hyperbilirubinemia.

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 Effect of regular third-trimester ultrasound examination on antenatal detection and perinatal outcomes of small for gestational age infants

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052198920
Author(s):  
Yan Wang ◽  
Jun Wei ◽  
Guoli Liu ◽  
Yani Yan ◽  
Zhenjuan Yang ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Neonatal Intensive Care ◽  
Elective Caesarean Section ◽  
Perinatal Outcomes ◽  
Third Trimester ◽  
Antenatal Ultrasound ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Antenatal Detection

Objective To assess the effect of regular third-trimester ultrasound on antenatal detection and perinatal outcomes of small for gestational age (SGA) infants. Methods Data from SGA infants delivered at ≥28 weeks’ gestation were retrospectively studied. Each pregnancy had undergone three regular third-trimester ultrasound examinations, and data were grouped according to with or without antenatal ultrasound suspicion of fetal growth restriction (FGR). Adjusted risk ratios (aRRs) of perinatal outcomes were analysed. Results A total of 407 infants were included, comprising 268 (65.85%) with antenatal ultrasound suspicion of FGR. Antenatal suspicion of FGR was associated with increased risk of iatrogenic delivery (aRR 2.03, 95% confidence interval [CI] 1.31, 3.14) that included risk of preterm birth (aRR 10.61, 95% CI 1.35, 83.62) and elective caesarean section (aRR 1.306, 95% CI 1.051, 1.623). Differences in fetal death, 1-min Apgar score, and admission to neonatal intensive care unit were not statistically significant. Resuscitation risk was reduced (aRR 0.22, 95% CI 0.06, 0.79). Conclusions Regular use of third-trimester ultrasound in one teaching hospital in China showed satisfactory antenatal detection of FGR among SGA infants. Ultrasound suspicion of FGR was associated with higher incidence of iatrogenic deliveries, but not improved neonatal outcomes, except for reduced perinatal resuscitation.

scholarly journals Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 853
Author(s):  
Sara Cruz Melguizo ◽  
María Luisa de la Cruz Conty ◽  
Paola Carmona Payán ◽  
Alejandra Abascal-Saiz ◽  
Pilar Pintando Recarte ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Perinatal Outcomes ◽  
Preterm Births ◽  
Hypertensive Disorder ◽  
Obstetric Emergency ◽  
Increased Risk ◽  
Emergency Group ◽  
Adverse Perinatal Outcomes ◽  
Maternal Disease ◽  
The Relationship

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients’ information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

Sign in / Sign up

Export Citation Format

Share Document