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Original Research: Obstetrics|Articles in Press

Reduced fetal growth velocity and weight loss are associated with adverse perinatal outcome in fetuses at risk of growth restriction

Open AccessPublished:June 22, 2022DOI:https://doi.org/10.1016/j.ajog.2022.06.023
Reduced fetal growth velocity and weight loss are associated with adverse perinatal outcome in fetuses at risk of growth restriction
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      Abstract

      Background

      While fetal size is associated with adverse perinatal outcome, the relationship between fetal growth velocity and adverse perinatal outcome is unclear.

      Objectives

      To evaluate the relationship between fetal growth velocity and signs of cerebral blood flow redistribution, and their association with birthweight and adverse perinatal outcome.

      Study Design

      Secondary analysis of the TRUFFLE 2 multicentre observational prospective feasibility study of fetuses at risk of fetal growth restriction between 32+0 and 36+6 weeks (n=856) evaluated by ultrasound biometry and umbilical and middle cerebral artery Doppler. Individual fetal growth velocity was calculated: from the difference of birthweight and estimated fetal weight at three, two and one week before delivery; and by linear regression of all available estimated fetal weight measurements. Fetal estimated weight and birthweight were expressed as absolute value and as multiple of the median for statistical calulation. The coefficients of the individual linear regression of estimated fetal weight measurements (growth velocity; grams/week) were plotted against the last umbilical-cerebral ratio with sub-classification for perinatal outcome. The association of these measurements with adverse perinatal outcome was assessed. The adverse perinatal outcome was a composite of abnormal condition at birth or major neonatal morbidity

      Results

      Adverse perinatal outcome was more frequent among fetuses whose antenatal growth was <100 grams/week, irrespective of signs of cerebral blood flow redistribution. Infants with birthweight <0.65 multiple of the median were enrolled earlier, had the lowest fetal growth velocity, higher umbilical-cerebral ratio and were more likely to have adverse perinatal outcome. A decreasing fetal growth velocity was observed in 163 (19%) women in whom the estimated fetal weight multiple of the median regression coefficient was <-0.025, and in these umbilical-cerebral ratio values were higher and the adverse perinatal outcome more frequent. Sixty-seven of these women (41%; 8% of total group) had negative growth velocity. Estimated fetal weight and umbilical-cerebral ratio at admission and fetal growth velocity combined by logistic regression had a higher association with adverse perinatal outcome than any of these parameters separately (relative risk 3.3; 95% confidence ratio 2.3-4.8).

      Conclusions

      In fetuses at risk of late preterm fetal growth restriction, reduced growth velocity is associated with an increased risk of adverse perinatal outcome, irrespective of signs of cerebral blood flow redistribution. Some fetuses showed negative growth velocity suggesting catabolic metabolism.

      Keywords

      Article Info

      Publication History

      Accepted: June 16, 2022
      Received in revised form: June 15, 2022
      Received: February 21, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      TRUFFLE-2 Feasibility Study Authors:

      Bine Arabin, Astrid Berger, Eva Bergman, Amarnath Bhide, Caterina M. Bilardo, Andrew C. Breeze, Jana Brodszki, Pavel Calda, Elena Cesari, Irene Cetin, Jan B. Derks, Catherine Ebbing, Enrico Ferrazzi, Tiziana Frusca, Wessel Ganzevoort, Sanne J. Gordijn, Wilfried Gyselaers, Kurt Hecher, Philipp Klaritsch, Ladislav Krofta, Peter Lindgren, Silvia M. Lobmaier, Gisuseppe M. Maruotti, Federico Mecacci, Kirsti Myklestad, Rafaele. Napolitano, Federico Prefumo, Luigi Raio, Jute Richter, Ragnar K. Sande, Jim Thornton, Herbert Valensise, Gerry H. A. Visser, Ling Wee.

      Conflict of interest declaration:

      The authors report no conflict of interest.

      CCL is supported by the UK National Institute for Health Research Biomedical Research Centre (BRC) based at Imperial College Healthcare National Health Service Trust and Imperial College.

      Part of the results were presented at the online 31st World Congress on Ultrasound in Obstetrics and Gynecology, 15-17 October 2021, London, UK.

      Condensation: In fetuses at risk of growth restriction, reduced growth velocity is associated with adverse perinatal outcome, irrespective of cerebral blood flow redistribution.

      A. Why the study was conducted:

      •To evaluate the growth velocity in fetuses at risk of growth restriction.

      •To assess the association of fetal growth velocity with adverse perinatal outcome and signs of cerebral blood flow redistribution.

      B. What are the key findings?

      •In the last week before delivery, the fetuses with lowest growth velocity showed no growth, and in some cases negative growth.

      •Fetal growth velocity <100 grams/week was associated with adverse perinatal outcome, irrespective of signs of cerebral blood flow redistribution.

      C. What does this study add to what is already known?

      •Fetal growth velocity is an important parameter that might identify fetuses at risk of adverse outcome irrespective of signs of cerebral blood flow redistribution, and might differentiate from constitutionally small fetuses.

      Identification

      DOI: https://doi.org/10.1016/j.ajog.2022.06.023

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      © 2022 The Authors. Published by Elsevier Inc.

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