Assessment of fetal growth trajectory identifies infants at high risk of perinatal mortality

M L Larsen; L Krebs; C E Hoei-Hansen; S Kumar

doi:10.1002/uog.27610

Assessment of fetal growth trajectory identifies infants at high risk of perinatal mortality

Ultrasound Obstet Gynecol. 2024 Feb 9. doi: 10.1002/uog.27610. Online ahead of print.

Authors

M L Larsen^{1

2

3}, L Krebs^{3

4}, C E Hoei-Hansen^{1

4}, S Kumar^{3

5

6}

Affiliations

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.

PMID: 38339783
DOI: 10.1002/uog.27610

Abstract

Objective: To analyze perinatal risks associated with three distinct scenarios of fetal growth trajectory in the latter half of pregnancy compared with a referent group.

Methods: This cohort study included women with singleton pregnancies that birthed between 32⁺⁰ and 41⁺⁶ gestational weeks and had two or more ultrasound scans at least four weeks apart from 18⁺⁰ weeks. We evaluated three different scenarios of fetal growth against a referent, defined as appropriate for gestational age-sized fetuses with appropriate forward growth trajectories. The comparator growth trajectories were categorized as Group 1: Small for gestational age (SGA) fetuses (EFW or AC <10^th centile) with appropriate forward growth; Group 2: Decreased growth trajectory fetuses (decrease of ≥50 centiles) with EFW or AC ≥10^th centile (i.e., non-SGA) at their final scan; and Group 3: Decreased growth trajectory fetuses with EFW or AC <10^th centile (i.e., SGA) at their final scan. The primary outcomes were perinatal mortality (stillbirth or neonatal death). Secondary outcomes included stillbirth, birth of an SGA infant, preterm birth, emergency cesarean section (CS) for non-reassuring fetal status (NRFS), and composite severe neonatal morbidity. Associations were analyzed using logistic regression.

Results: The final study cohort comprised 5319 pregnancies. Compared to the referent group, the adjusted odds of perinatal mortality were significantly increased in Group 2 (odds ratio [OR] 4.00, 95%CI 1.36-11.22) and Group 3 (OR 7.71, 95%CI 2.39-24.91). Only Group 3 had increased odds of stillbirth (OR 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 an SGA infant at birth increased in all three groups but were highest in Group 1 (OR 111.86, 95%CI 62.58-199.95) and Group 3 (OR 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 <3^rd centile. Likewise, the odds of preterm birth were increased in all three groups, being the highest in Group 3 with an OR of 4.27 (3.23-5.64). Lastly, the odds of severe neonatal morbidity were increased in Groups 1 and 3, whereas the odds of emergency CS for NRFS were only increased in Group 3.

Conclusions: Assessing the fetal growth trajectory in the latter half of pregnancy can help identify infants at increased risk of perinatal mortality and birth weight <3^rd centile for gestation. This article is protected by copyright. All rights reserved.

Keywords: Pregnancy; cerebroplacental ratio; fetal growth restriction; fetal growth trajectory; fetal growth velocity; perinatal mortality; small-for-gestational age; stillbirth; umbilical artery Doppler.