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

Tamara Stampalija; Hans Wolf; Bronacha Mylrea-Foley; Neil Marlow; Katie J Stephens; Caroline J Shaw; Christoph C Lees; TRUFFLE-2 Feasibility Study authors

doi: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

Standard

Reduced fetal growth velocity and weight loss are associated with adverse perinatal outcome in fetuses at risk of growth restriction. / Stampalija, Tamara; Wolf, Hans; Mylrea-Foley, Bronacha; Marlow, Neil; Stephens, Katie J; Shaw, Caroline J; Lees, Christoph C; TRUFFLE-2 Feasibility Study authors.

In: AM J OBSTET GYNECOL, Vol. 228, No. 1, 01.2023, p. 71.e1-71.e10.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Stampalija, T, Wolf, H, Mylrea-Foley, B, Marlow, N, Stephens, KJ, Shaw, CJ, Lees, CC & TRUFFLE-2 Feasibility Study authors 2023, 'Reduced fetal growth velocity and weight loss are associated with adverse perinatal outcome in fetuses at risk of growth restriction', AM J OBSTET GYNECOL, vol. 228, no. 1, pp. 71.e1-71.e10. https://doi.org/10.1016/j.ajog.2022.06.023

APA

Stampalija, T., Wolf, H., Mylrea-Foley, B., Marlow, N., Stephens, K. J., Shaw, C. J., Lees, C. C., & TRUFFLE-2 Feasibility Study authors (2023). Reduced fetal growth velocity and weight loss are associated with adverse perinatal outcome in fetuses at risk of growth restriction. AM J OBSTET GYNECOL, 228(1), 71.e1-71.e10. https://doi.org/10.1016/j.ajog.2022.06.023

Vancouver

Stampalija T, Wolf H, Mylrea-Foley B, Marlow N, Stephens KJ, Shaw CJ et al. Reduced fetal growth velocity and weight loss are associated with adverse perinatal outcome in fetuses at risk of growth restriction. AM J OBSTET GYNECOL. 2023 Jan;228(1):71.e1-71.e10. https://doi.org/10.1016/j.ajog.2022.06.023

Bibtex

@article{bdc3f877c022458f9e9c6916922132a4,

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

abstract = "BACKGROUND: Although fetal size is associated with adverse perinatal outcome, the relationship between fetal growth velocity and adverse perinatal outcome is unclear.OBJECTIVE: This study aimed 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: This study was a secondary analysis of the TRUFFLE-2 multicenter observational prospective feasibility study of fetuses at risk of fetal growth restriction between 32+0 and 36+6 weeks of gestation (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 3, 2, and 1 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 calculation. The coefficients of the individual linear regression of estimated fetal weight measurements (growth velocity; g/wk) were plotted against the last umbilical-cerebral ratio with subclassification 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 g/wk, 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 who had higher umbilical-cerebral ratio values and more frequent adverse perinatal outcome; 67 (41%; 8% of total group) of these women 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 those parameters separately (relative risk, 3.3; 95% confidence interval, 2.3-4.8).CONCLUSION: 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 = "Infant, Newborn, Infant, Pregnancy, Female, Humans, Male, Birth Weight/physiology, Fetal Growth Retardation/diagnosis, Fetal Weight, Prospective Studies, Umbilical Arteries/physiology, Fetal Development, Fetus, Weight Loss, Ultrasonography, Prenatal, Ultrasonography, Doppler",

author = "Tamara Stampalija and Hans Wolf and Bronacha Mylrea-Foley and Neil Marlow and Stephens, {Katie J} and Shaw, {Caroline J} and Lees, {Christoph C} and {TRUFFLE-2 Feasibility Study authors} and Kurt Hecher",

year = "2023",

month = jan,

doi = "10.1016/j.ajog.2022.06.023",

language = "English",

volume = "228",

pages = "71.e1--71.e10",

journal = "AM J OBSTET GYNECOL",

issn = "0002-9378",

publisher = "Mosby Inc.",

number = "1",

}

RIS

TY - JOUR

T1 - Reduced fetal growth velocity and weight loss are associated with adverse perinatal outcome in fetuses at risk of growth restriction

AU - Stampalija, Tamara

AU - Wolf, Hans

AU - Mylrea-Foley, Bronacha

AU - Marlow, Neil

AU - Stephens, Katie J

AU - Shaw, Caroline J

AU - Lees, Christoph C

AU - TRUFFLE-2 Feasibility Study authors

AU - Hecher, Kurt

PY - 2023/1

Y1 - 2023/1

N2 - BACKGROUND: Although fetal size is associated with adverse perinatal outcome, the relationship between fetal growth velocity and adverse perinatal outcome is unclear.OBJECTIVE: This study aimed 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: This study was a secondary analysis of the TRUFFLE-2 multicenter observational prospective feasibility study of fetuses at risk of fetal growth restriction between 32+0 and 36+6 weeks of gestation (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 3, 2, and 1 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 calculation. The coefficients of the individual linear regression of estimated fetal weight measurements (growth velocity; g/wk) were plotted against the last umbilical-cerebral ratio with subclassification 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 g/wk, 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 who had higher umbilical-cerebral ratio values and more frequent adverse perinatal outcome; 67 (41%; 8% of total group) of these women 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 those parameters separately (relative risk, 3.3; 95% confidence interval, 2.3-4.8).CONCLUSION: 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.

AB - BACKGROUND: Although fetal size is associated with adverse perinatal outcome, the relationship between fetal growth velocity and adverse perinatal outcome is unclear.OBJECTIVE: This study aimed 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: This study was a secondary analysis of the TRUFFLE-2 multicenter observational prospective feasibility study of fetuses at risk of fetal growth restriction between 32+0 and 36+6 weeks of gestation (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 3, 2, and 1 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 calculation. The coefficients of the individual linear regression of estimated fetal weight measurements (growth velocity; g/wk) were plotted against the last umbilical-cerebral ratio with subclassification 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 g/wk, 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 who had higher umbilical-cerebral ratio values and more frequent adverse perinatal outcome; 67 (41%; 8% of total group) of these women 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 those parameters separately (relative risk, 3.3; 95% confidence interval, 2.3-4.8).CONCLUSION: 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.

KW - Infant, Newborn

KW - Infant

KW - Pregnancy

KW - Female

KW - Humans

KW - Male

KW - Birth Weight/physiology

KW - Fetal Growth Retardation/diagnosis

KW - Fetal Weight

KW - Prospective Studies

KW - Umbilical Arteries/physiology

KW - Fetal Development

KW - Fetus

KW - Weight Loss

KW - Ultrasonography, Prenatal

KW - Ultrasonography, Doppler

U2 - 10.1016/j.ajog.2022.06.023

DO - 10.1016/j.ajog.2022.06.023

M3 - SCORING: Journal article

C2 - 35752304

VL - 228

SP - 71.e1-71.e10

JO - AM J OBSTET GYNECOL

JF - AM J OBSTET GYNECOL

SN - 0002-9378

IS - 1

ER -