Affiliation:
1. Center for Cerebral Palsy, Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital ‐ Rigshospitalet Copenhagen Denmark
2. Department of Obstetrics and Gynecology Copenhagen University Hospital – Amager‐Hvidovre Hvidovre Denmark
3. Mater Research Institute University of Queensland Brisbane Queensland Australia
4. Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
5. Centre for Maternal and Fetal Medicine Mater Mother's Hospital Brisbane Queensland Australia
6. NHMRC Centre for Research Excellence in Stillbirth, Mater Research Institute University of Queensland Brisbane Queensland Australia
Abstract
ABSTRACTObjectiveTo analyze perinatal risks associated with three distinct scenarios of fetal growth trajectory in the latter half of pregnancy compared with a reference group.MethodsThis cohort study included women with a singleton pregnancy that delivered between 32 + 0 and 41 + 6 weeks' gestation and had two or more ultrasound scans, at least 4 weeks apart, from 18 + 0 weeks. We evaluated three different scenarios of fetal growth against a reference group, which comprised appropriate‐for‐gestational‐age fetuses with appropriate forward‐growth trajectory. The comparator growth trajectories were categorized as: Group 1, small‐for‐gestational‐age (SGA) fetuses (estimated fetal weight (EFW) or abdominal circumference (AC) persistently < 10th centile) with appropriate forward growth; Group 2, fetuses with decreased growth trajectory (decrease of ≥ 50 centiles) and EFW or AC ≥ 10th centile (i.e. non‐SGA) at their final ultrasound scan; and Group 3, fetuses with decreased growth trajectory and EFW or AC < 10th centile (i.e. SGA) at their final scan. The primary outcome was overall perinatal mortality (stillbirth or neonatal death). Secondary outcomes included stillbirth, delivery of a SGA infant, preterm birth, emergency Cesarean section for non‐reassuring fetal status and composite severe neonatal morbidity. Associations were analyzed using logistic regression.ResultsThe final study cohort comprised 5319 pregnancies. Compared to the reference group, the adjusted odds of perinatal mortality were increased significantly in Group 2 (adjusted odds ratio (aOR), 4.00 (95% CI, 1.36–11.22)) and Group 3 (aOR, 7.71 (95% CI, 2.39–24.91)). Only Group 3 had increased odds of stillbirth (aOR, 5.69 (95% CI, 1.55–20.93)). In contrast, infants in Group 1 did not have significantly increased odds of demise. The odds of a SGA infant at birth were increased in all three groups compared with the reference group, but was highest in Group 1 (aOR, 111.86 (95% CI, 62.58–199.95)) and Group 3 (aOR, 40.63 (95% CI, 29.01–56.92)). In both groups, more than 80% of infants were born SGA and nearly half had a birth weight < 3rd centile. Likewise, the odds of preterm birth were increased in all three groups compared with the reference group, being highest in Group 3, with an aOR of 4.27 (95% CI, 3.23–5.64). Lastly, the odds of composite severe neonatal morbidity were increased in Groups 1 and 3, whereas the odds of emergency Cesarean section for non‐reassuring fetal status were increased only in Group 3.ConclusionAssessing the fetal growth trajectory in the latter half of pregnancy can help identify infants at increased risk of perinatal mortality and birth weight < 3rd centile for gestation. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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