Recurrence Risk of Fetal Growth Restriction: Management of Subsequent Pregnancies

Obstet Gynecol Clin North Am. 2021 Jun;48(2):419-436. doi: 10.1016/j.ogc.2021.03.002.

Abstract

Fetal growth restriction (FGR) is a common obstetric complication that predisposes to mortality across the lifespan. Women with a prior pregnancy affected by FGR have a 20% to 30% risk of recurrence, but effective preventive strategies are lacking. Pharmacologic interventions to prevent FGR are lacking. Low-dose aspirin may be somewhat effective, but low-molecular-weight heparin and sildenafil are not. Surveillance in a subsequent pregnancy may consist of serial ultrasonography with timing and frequency determined by the clinical severity in the index pregnancy. Once FGR is diagnosed, the principal management strategy consists of close surveillance and carefully timed delivery.

Keywords: Fetal growth restriction; Low-dose aspirin; Low-molecular-weight heparin; Perinatal morbidity; Prevention; Recurrence; Small for gestational age; Stillbirth.

Publication types

  • Review

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use
  • Aspirin / therapeutic use
  • Delivery, Obstetric / methods
  • Female
  • Fetal Growth Retardation / epidemiology
  • Fetal Growth Retardation / prevention & control*
  • Fetal Growth Retardation / therapy*
  • Gestational Age
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Infant, Small for Gestational Age
  • Middle Aged
  • Pre-Eclampsia / therapy
  • Pregnancy
  • Pregnancy Outcome
  • Recurrence
  • Risk Factors
  • Smoking / epidemiology
  • Stillbirth / epidemiology
  • Ultrasonography, Prenatal / methods

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight
  • Aspirin