Advertisement

Fetal and neonatal outcomes of preterm infants born before 32 weeks of gestation according to antenatal vs postnatal assessments of restricted growth

  • Isabelle Monier
    Correspondence
    Corresponding author: Isabelle Monier, RM, MSc.
    Affiliations
    Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France

    Antoine Beclere Maternity Unit, Department of Obstetrics and Gynaecology, South Paris University Hospitals, AP-HP, Paris, France
    Search for articles by this author
  • Pierre-Yves Ancel
    Affiliations
    Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France

    URC - CIC P1419, AP-HP, Hôpital Cochin, Paris, France
    Search for articles by this author
  • Anne Ego
    Affiliations
    Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France

    Clinical Research Center (CICO3), Grenoble University Hospital, Grenoble, France
    Search for articles by this author
  • Pierre-Henri Jarreau
    Affiliations
    Department of Neonatal Medicine and Intensive Care Unit of Port-Royal, Cochin University Hospital, AP-HP, DHU Risks in Pregnancy, Paris, France
    Search for articles by this author
  • Cécile Lebeaux
    Affiliations
    Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
    Search for articles by this author
  • Monique Kaminski
    Affiliations
    Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
    Search for articles by this author
  • François Goffinet
    Affiliations
    Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France

    Port-Royal Maternity Unit, Department of Obstetrics and Gynaecology, Cochin University Hospital, AP-HP, Paris, France
    Search for articles by this author
  • Jennifer Zeitlin
    Affiliations
    Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
    Search for articles by this author
  • for theEPIPAGE 2 Study Group
Published:February 08, 2017DOI:https://doi.org/10.1016/j.ajog.2017.02.001

      Background

      Fetal growth restriction is defined using ultrasound parameters during pregnancy or as a low birthweight for gestational age after birth, but these definitions are not always concordant.

      Objective

      The purpose of this study was to investigate fetal and neonatal outcomes based on antenatal vs postnatal assessments of growth restriction.

      Study Design

      From the EPIPAGE 2 population-based prospective study of very preterm births in France in 2011, we included 2919 singleton nonanomalous infants 24–31 weeks gestational age. We constituted 4 groups based on whether the infant was suspected with fetal growth restriction during pregnancy and/or was small for gestational age with a birthweight <10th percentile of intrauterine norms by sex: 1) suspected with fetal growth restriction/small for gestational age 2) not suspected with fetal growth restriction/small for gestational age 3) suspected with fetal growth restriction/not small for gestational age and 4) not suspected with fetal growth restriction/not small for gestational age. We estimated relative risks of perinatal mortality and morbidity for these groups adjusting for maternal and neonatal characteristics.

      Results

      We found that 22.2% of infants were suspected with fetal growth restriction/small for gestational age, that 11.4% infants were not suspected with fetal growth restriction/small for gestational age, that 3.0% infants were suspected with fetal growth restriction/not small for gestational age, and that 63.4% infants were not suspected with fetal growth restriction/not small for gestational age. Compared with infants who were not suspected with fetal growth restriction/not small-for-gestational-age infants, small-for-gestational-age infants suspected and not suspected with fetal growth restriction had higher risks of stillbirth or termination of pregnancy (adjusted relative risk, 2.0 [95% confidence interval, 1.6–2.5] and adjusted relative risk, 2.8 [95% confidence interval, 2.2–3.4], respectively), in-hospital death (adjusted relative risk, 2.8 [95% confidence interval, 2.0–3.7] and adjusted relative risk, 2.0 [95% confidence interval, 1.5–2.8], respectively), and bronchopulmonary dysplasia (adjusted relative risk, 1.3 [95% confidence interval, 1.2–1.4] and adjusted relative risk, 1.3 [95% confidence interval, 1.1–1.4], respectively), but not severe brain lesions. Risks were not increased for infants suspected with fetal growth restriction but not small-for-gestational-age.

      Conclusion

      Antenatal and postnatal assessments of fetal growth restriction were not concordant for 14% of very preterm infants. In these cases, birthweight appears to be the more relevant parameter for the identification of infants with higher risks of adverse short-term outcomes.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • McIntire D.D.
        • Bloom S.L.
        • Casey B.M.
        • Leveno K.J.
        Birth weight in relation to morbidity and mortality among newborn infants.
        N Engl J Med. 1999; 340: 1234-1238
        • Danielian P.J.
        • Allman A.C.
        • Steer P.J.
        Is obstetric and neonatal outcome worse in fetuses who fail to reach their own growth potential?.
        BJOG. 1992; 99: 452-454
        • Mahadevan N.
        • Pearce M.
        • Steer P.
        The proper measure of intrauterine growth retardation is function, not size.
        BJOG. 1994; 101: 1032-1035
        • Royal College of Obstetricians and Gynecologists
        The investigation and management of the small-for-gestational fetus. Green-top Guideline No.31, 2nd Edition.
        Royal College of Obstetricians and Gynecologists, London, UK2013
        • Vayssiere C.
        • Sentilhes L.
        • Ego A.
        • et al.
        Fetal growth restriction and intra-uterine growth restriction: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians.
        Eur J Obstet Gynecol Reprod Biol. 2015; 193: 10-18
        • Gordijn S.J.
        • Beune I.M.
        • Thilaganathan B.
        • et al.
        Consensus definition of fetal growth restriction: a Delphi procedure.
        Ultrasound Obstet Gynecol. 2016; 48: 333-339
        • Goldenberg R.L.
        • Culhane J.F.
        • Iams J.D.
        • Romero R.
        Epidemiology and causes of preterm birth.
        Lancet. 2008; 371: 75-84
        • Ananth C.V.
        • Vintzileos A.M.
        Maternal-fetal conditions necessitating a medical intervention resulting in preterm birth.
        Am J Obstet Gynecol. 2006; 195: 1557-1563
        • Delorme P.
        • Goffinet F.
        • Ancel P.Y.
        • et al.
        Cause of preterm birth as a prognostic factor for mortality.
        Obstet Gynecol. 2016; 127: 40-48
        • Lees C.
        • Marlow N.
        • Arabin B.
        • et al.
        Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE).
        Ultrasound Obstet Gynecol. 2013; 42: 400-408
        • El Ayoubi M.
        • Jarreau P.H.
        • Van Reempts P.
        • et al.
        Does the antenatal detection of fetal growth restriction (FGR) have a prognostic value for mortality and short-term morbidity for very preterm infants? Results from the MOSAIC cohort.
        J Matern Fetal Neonatal Med. 2016; 29: 596-601
        • Monier I.
        • Blondel B.
        • Ego A.
        • Kaminski M.
        • Goffinet F.
        • Zeitlin J.
        Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study.
        BJOG. 2015; 122: 518-527
        • American Congress of Obstetricians and Gynecologists
        ACOG Practice bulletin no. 134: fetal growth restriction.
        Obstet Gynecol. 2013; 121: 1122-1133
        • Garite T.J.
        • Clark R.
        • Thorp J.A.
        Intrauterine growth restriction increases morbidity and mortality among premature neonates.
        Am J Obstet Gynecol. 2004; 191: 481-487
        • Ancel P.Y.
        • Goffinet F.
        • Group E.W.
        EPIPAGE 2: a preterm birth cohort in France in 2011.
        BMC Pediatr. 2014; 14: 97
        • Garg P.
        • Abdel-Latif M.E.
        • Bolisetty S.
        • Bajuk B.
        • Vincent T.
        • Lui K.
        Perinatal characteristics and outcome of preterm singleton, twin and triplet infants in NSW and the ACT, Australia (1994-2005).
        Arch Dis Child Fetal Neonatal Ed. 2010; 95: F20-F24
        • Moriette G.
        • Rameix S.
        • Azria E.
        • et al.
        [Very premature births: Dilemmas and management. Part 1. Outcome of infants born before 28 weeks of postmenstrual age, and definition of a gray zone].
        Arch Pediatr. 2010; 17: 518-526
        • Torchin H.
        • Ancel P.Y.
        • Goffinet F.
        • et al.
        Placental complications and bronchopulmonary dysplasia: EPIPAGE-2 Cohort Study.
        Pediatrics. 2016; 137: 1-10
        • Ego A.
        • Prunet C.
        • Lebreton E.
        • et al.
        [Customized and non-customized French intrauterine growth curves. I - Methodology].
        J Gynecol Obstet Biol Reprod. 2016; 45: 155-164
      1. Haute Autorité de Santé. Suivi et orientation des femmes enceintes en fonction des situations à risque identifiées. Recommandations professionnelles. 2007. Available at: www.has-sante.fr. Accessed February 5, 2015.

        • Vayssiere C.
        • Haumonte J.B.
        • Chantry A.
        • et al.
        Prolonged and post-term pregnancies: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF).
        Eur J Obstet Gynecol Reprod Biol. 2013; 169: 10-16
      2. Rapport du Comité National Technique de l’Echographie de dépistage prénatal. Avril 2005. Available at: http://www.cfef.org/archives/lettres/DocusCTE/rapportCTE.pdf. Accessed September 12, 2016.

        • Gardosi J.
        • Mongelli M.
        • Wilcox M.
        • Chang A.
        An adjustable fetal weight standard.
        Ultrasound Obstet Gynecol. 1995; 6: 168-174
        • Marsal K.
        • Persson P.H.
        • Larsen T.
        • Lilja H.
        • Selbing A.
        • Sultan B.
        Intrauterine growth curves based on ultrasonically estimated foetal weights.
        Acta Paediatrica. 1996; 85: 843-848
        • Salomon L.J.
        • Bernard J.P.
        • Ville Y.
        Estimation of fetal weight: reference range at 20-36 weeks’ gestation and comparison with actual birth-weight reference range.
        Ultrasound Obstet Gynecol. 2007; 29: 550-555
        • Ego A.
        • Prunet C.
        • Blondel B.
        • Kaminski M.
        • Goffinet F.
        • Zeitlin J.
        [Customized and non-customized French intrauterine growth curves. II - Comparison with existing curves and benefits of customization].
        J Gynecol Obstet Biol Reprod. 2016; 45: 165-176
        • Gardosi J.
        • Madurasinghe V.
        • Williams M.
        • Malik A.
        • Francis A.
        Maternal and fetal risk factors for stillbirth: population based study.
        BMJ. 2013; 346: f108
        • Jobe A.H.
        • Bancalari E.
        Bronchopulmonary dysplasia.
        Am J Respi Crit Care Med. 2001; 163: 1723-1729
        • Volpe J.J.
        Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances.
        Lancet Neurol. 2009; 8: 110-124
        • Zou G.
        A modified poisson regression approach to prospective studies with binary data.
        Am Jl Epidemiol. 2004; 159: 702-706
      3. [Perinatal care: The government plan 1995-2000.] Soins Gynecol Obstet Pueric Pediatr 1994;156:43-5.

        • Man J.
        • Hutchinson J.C.
        • Ashworth M.
        • Heazell A.E.
        • Levine S.
        • Sebire N.J.
        Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy.
        Ultrasound Obstet Gynecol. 2016 Oct 25; ([Epub ahead of print])
        • Bernstein I.M.
        • Horbar J.D.
        • Badger G.J.
        • Ohlsson A.
        • Golan A.
        Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction: The Vermont Oxford Network.
        Am J Obstet Gynecol. 2000; 182: 198-206
        • De Jesus L.C.
        • Pappas A.
        • Shankaran S.
        • et al.
        Outcomes of small for gestational age infants born at <27 weeks’ gestation.
        J Pediatr. 2013; 163 (e1-3): 55-60
        • Zeitlin J.
        • El Ayoubi M.
        • Jarreau P.H.
        • et al.
        Impact of fetal growth restriction on mortality and morbidity in a very preterm birth cohort.
        J Pediatr. 2010; 157: 733-739.e1
        • Monier I.
        • Blondel B.
        • Ego A.
        • Kaminski M.
        • Goffinet F.
        • Zeitlin J.
        Does the presence of risk factors for fetal growth restriction increase the probability of antenatal detection? A French National Study.
        Paediatr Perinatal Epidemiol. 2016; 30: 46-55
        • Copel J.A.
        • Bahtiyar M.O.
        A practical approach to fetal growth restriction.
        Obstet Gynecol. 2014; 123: 1057-1069
        • Dudley N.J.
        A systematic review of the ultrasound estimation of fetal weight.
        Ultrasound Obstet Gynecol. 2005; 25: 80-89
        • Cartlidge P.H.
        • Stewart J.H.
        Survival of very low birthweight and very preterm infants in a geographically defined population.
        Acta Paediatrica. 1997; 86: 105-110
        • Grisaru-Granovsky S.
        • Reichman B.
        • Lerner-Geva L.
        • et al.
        Mortality and morbidity in preterm small-for-gestational-age infants: a population-based study.
        Am J Obstet Gynecol. 2012; 206: 150.e1-150.e7
        • El Ayoubi M.
        • Patkai J.
        • Bordarier C.
        • et al.
        Impact of fetal growth restriction on neurodevelopmental outcome at 2 years for extremely preterm infants: a single institution study.
        Dev Med Child Neurol. 2016; 58: 1249-1256
        • Lindqvist P.G.
        • Molin J.
        Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome?.
        Ultrasound Obstet Gynecol. 2005; 25: 258-264
        • Stratton J.F.
        • Scanaill S.N.
        • Stuart B.
        • Turner M.J.
        Are babies of normal birth weight who fail to reach their growth potential as diagnosed by ultrasound at increased risk?.
        Ultrasound Obstet Gynecol. 1995; 5: 114-118
        • Sovio U.
        • White I.R.
        • Dacey A.
        • Pasupathy D.
        • Smith G.C.
        Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study.
        Lancet. 2015; 386: 2089-2097