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
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Article Info
Publication History
Published online: February 08, 2017
Accepted:
February 1,
2017
Received in revised form:
January 16,
2017
Received:
September 26,
2016
Footnotes
Supported by the French Institute of Public Health Research/Institute of Public Health and its partners: the French Health Ministry , the National Institute of Health and Medical Research (INSERM), the National Institute of Cancer , and the National Solidarity Fund for Autonomy (CNSA); the French EQUIPEX programme of investments in the future; and the PREMUP Foundation. I.M. was supported by a research grant from The Assistance Publique-Hôpitaux de Paris (AP-HP).
The authors report no conflict of interest.
Cite this article as: Monier I, Ancel P-Y, Ego A, et al. Fetal and neonatal outcomes of preterm infants born before 32 weeks of gestation according to antenatal vs postnatal assessments of restricted growth. Am J Obstet Gynecol 2017;216:516.e1-10.
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