Objective:This study aimed to assess perinatal morbidity, mortality rates, and
neurodevelopmental outcomes in the management of fetal growth restriction (FGR)
at a single tertiary institute. Methods: Among 2465 deliveries between
2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes,
indications for pregnancy termination, perinatal death, overall neonatal
outcomes, and long-term prognosis. Results: Excluding FGR due to
congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate
delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of
prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were
present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly
lower gestational age at delivery, lower birth weight, and higher umbilical
artery resistance indices were observed in neonates with neurodevelopmental
disorders. Conclusions:Intact survival before 27 weeks of gestation at delivery with FGR is
uncommon. Neurodevelopmental
disorders may still develop after delivery at 32 - 38 weeks;
consideration should be given to the timing of delivery usingfetal ductus
venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.
References
[1]
(2021) Fetal Growth Restriction: ACOG Practice Bulletin, Number 227. Obstetrics and Gynecology, 137, E16-E28. https://doi.org/10.1097/AOG.0000000000004251
[2]
Von Beckerath, A.K., Kollmann, M., Rotky-Fast, C., Karpf, E., Lang, U. and Klaritsch, P. (2013) Perinatal Complications and Long-Term Neurodevelopmental Outcome of Infants with Intrauterine Growth Restriction. American Journal of Obstetrics and Gynecology, 208, 130.E1-130.E6. https://doi.org/10.1016/j.ajog.2012.11.014
[3]
Lees, C., Marlow, N., Arabin, B., Bilardo, C.M., Brezinka, C., Derks, J.B., et al. (2013) Perinatal Morbidity and Mortality in Early-Onset Fetal Growth Restriction: Cohort Outcomes of the Trial of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE). Ultrasound in Obstetrics & Gynecology, 42, 400-408.
https://doi.org/10.1002/uog.13190
[4]
Doyle, L.W. (2011) Long-Term Neurologic Outcome for the Very Preterm Growth-Restricted Fetus. Pediatrics, 127, e1048-e1049.
https://doi.org/10.1542/peds.2011-0262
[5]
Løhaugen, G.C., Østgård, H.F., Andreassen, S., Jacobsen, G.W., Vik, T., Brubakk, A.M., et al. (2013) Small for Gestational Age and Intrauterine Growth Restriction Decreases Cognitive Function in Young Adults. The Journal of Pediatrics, 163, 447-453. https://doi.org/10.1016/j.jpeds.2013.01.060
[6]
Caradeux, J., Martinez-Portilla, R.J., Basuki, T.R., Kiserud, T. and Figueras, F. (2018) Risk of Fetal Death in Growth-Restricted Fetuses with Umbilical and/or Ductus Venosus Absent or Reversed End-Diastolic Velocities before 34 Weeks of Gestation: A Systematic Review and Meta-Analysis. American Journal of Obstetrics and Gynecology, 218, S774-S782.E21. https://doi.org/10.1016/j.ajog.2017.11.566
[7]
Martins, J.G., Biggio, J.R. and Abuhamad, A. (2020) Society for Maternal-Fetal Medicine Consult Series #52: Diagnosis and Management of Fetal Growth Restriction: (Replaces Clinical Guideline Number 3, April 2012). American Journal of Obstetrics and Gynecology, 223, B2-B17. https://doi.org/10.1016/j.ajog.2020.05.010
[8]
Minakami, H., Hiramatsu, Y., Koresawa, M., Fujii, T., Hamada, H., Iitsuka, Y., et al. (2011) Guidelines for Obstetrical Practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2011 Edition. The Journal of Obstetrics and Gynaecology Research, 37, 1174-1197. https://doi.org/10.1111/j.1447-0756.2011.01653.x
[9]
Savchev, S., Figueras, F., Sanz-Cortes, M., Cruz-Lemini, M., Triunfo, S., Botet, F., et al. (2014) Evaluation of an Optimal Gestational Age Cut-Off for the Definition of Early- and Late-Onset Fetal Growth Restriction. Fetal Diagnosis and Therapy, 36, 99-105. https://doi.org/10.1159/000355525
[10]
Dall’Asta, A., Girardelli, S., Usman, S., Lawin-O’Brien, A., Paramasivam, G., Frusca, T., et al. (2020) Etiology and Perinatal Outcome of Periviable Fetal Growth Restriction Associated with Structural or Genetic Anomaly. Ultrasound in Obstetrics & Gynecology, 55, 368-374. https://doi.org/10.1002/uog.20368
[11]
Ministry of Health, Labour and Welfare (2019) National Health and Nutritional Investigation in 2019. https://www.mhlw.go.jp/stf/newpage_14156.html
[12]
Savchev, S., Figueras, F., Cruz-Martinez, R., Illa, M., Botet, F. and Gratacos, E. (2012) Estimated Weight Centile as a Predictor of Perinatal Outcome in Small-for-Gestational-Age Pregnancies with Normal Fetal and Maternal Doppler Indices. Ultrasound in Obstetrics & Gynecology, 39, 299-303.
https://doi.org/10.1002/uog.10150
[13]
Pilliod, R.A., Cheng, Y.W., Snowden, J.M., Doss, A.E. and Caughey, A.B. (2012) The Risk of Intrauterine Fetal Death in the Small-For-Gestational-Age Fetus. American Journal of Obstetrics and Gynecology, 207, 318.E1-318.E6.
https://doi.org/10.1016/j.ajog.2012.06.039
[14]
Dall’Asta, A., Brunelli, V., Prefumo, F., Frusca, T. and Lees, C.C. (2017) Early Onset Fetal Growth Restriction. Maternal Health, Neonatology and Perinatology, 3, Article No. 2. https://doi.org/10.1186/s40748-016-0041-x
[15]
Blue, N.R., Page, J.M. and Silver, R.M. (2021) Recurrence Risk of Fetal Growth Restriction: Management of Subsequent Pregnancies. Obstetrics and Gynecology Clinics of North America, 48, 419-436. https://doi.org/10.1016/j.ogc.2021.03.002
[16]
Roberge, S., Nicolaides, K., Demers, S., Hyett, J., Chaillet, N. and Bujold, E. (2017) The Role of Aspirin Dose on the Prevention of Preeclampsia and Fetal Growth Restriction: Systematic Review and Meta-Analysis. American Journal of Obstetrics and Gynecology, 216, 110-120.E6. https://doi.org/10.1016/j.ajog.2016.09.076
[17]
Meher, S., Duley, L., Hunter, K. and Askie, L. (2017) Antiplatelet Therapy before or after 16 Weeks’ Gestation for Preventing Preeclampsia: An Individual Participant Data Meta-Analysis. American Journal of Obstetrics and Gynecology, 216, 121-128.E2.
https://doi.org/10.1016/j.ajog.2016.10.016
[18]
Duley, L., Meher, S., Hunter, K.E., Seidler, A.L. and Askie, L.M. (2019) Antiplatelet Agents for Preventing Pre-Eclampsia and Its Complications. The Cochrane Database of Systematic Reviews, 2019, CD004659.
https://doi.org/10.1002/14651858.CD004659.pub3
[19]
Rolnik, D.L., Wright, D., Poon, L.C., O’Gorman, N., Syngelaki, A., De Paco Matallana, C., et al. (2017) Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. The New England Journal of Medicine, 377, 613-622.
https://doi.org/10.1056/NEJMoa1704559
[20]
Groom, K.M. and David, A.L. (2018) The Role of Aspirin, Heparin, and Other Interventions in the Prevention and Treatment of Fetal Growth Restriction. American Journal of Obstetrics and Gynecology, 218, S829-S840.
https://doi.org/10.1016/j.ajog.2017.11.565
[21]
Groom, K.M., McCowan, L.M., Mackay, L.K., Lee, A.C., Said, J.M., Kane, S.C., et al. (2017) Enoxaparin for the Prevention of Preeclampsia and Intrauterine Growth Restriction in Women with a History: A Randomized Trial. American Journal of Obstetrics and Gynecology, 216, 296.E1-296.E14.
https://doi.org/10.1016/j.ajog.2017.01.014
[22]
Groom, K.M., McCowan, L.M., Mackay, L.K., Lee, A.C., Gardener, G., Unterscheider, J., et al. (2019) STRIDER NZAus: A MulticentreRandomised Controlled Trial of Sildenafil Therapy in Early-Onset Fetal Growth Restriction. BJOG, 126, 997-1006. https://doi.org/10.1111/1471-0528.15658
[23]
Maki, S., Tanaka, H., Tsuji, M., Furuhashi, F., Magawa, S., Kaneda, M.K., et al. (2019) Safety Evaluation of Tadalafil Treatment for Fetuses with Early-Onset Growth Restriction (TADAFER): Results from the Phase II Trial. Journal of Clinical Medicine, 8, Article 856. https://doi.org/10.3390/jcm8060856
[24]
Geva, R., Eshel, R., Leitner, Y., Valevski, A.F. and Harel, S. (2006) Neuropsychological Outcome of Children with Intrauterine Growth Restriction: A 9-Year Prospective Study. Pediatrics, 118, 91-100. https://doi.org/10.1542/peds.2005-2343
[25]
Paz, I., Laor, A., Gale, R., Harlap, S., Stevenson, D.K. and Seidman, D.S. (2001) Term Infants with Fetal Growth Restriction Are Not at Increased Risk for Low Intelligence Scores at Age 17 Years. The Journal of Pediatrics, 138, 87-91.
https://doi.org/10.1067/mpd.2001.110131
[26]
Theodore, R.F., Thompson, J.M., Waldie, K.E., Becroft, D.M., Robinson, E., Wild, C.J., et al. (2009) Determinants of Cognitive Ability at 7 Years: A Longitudinal Case-Control Study of Children Born Small-for-Gestational Age at Term. European Journal of Pediatrics, 168, 1217-1224. https://doi.org/10.1007/s00431-008-0913-9
[27]
Egaña-Ugrinovic, G., Sanz-Cortés, M., Couve-Pérez, C., Figueras, F. and Gratacós, E. (2014) Corpus Callosum Differences Assessed by Fetal MRI in Late-Onset Intrauterine Growth Restriction and Its Association with Neurobehavior. Prenatal Diagnosis, 34, 843-849. https://doi.org/10.1002/pd.4381
[28]
Lees, C.C., Romero, R., Stampalija, T., Dall’Asta, A., DeVore, G.A., Prefumo, F., et al. (2022) Clinical Opinion: The Diagnosis and Management of Suspected Fetal Growth Restriction: An Evidence-Based Approach. American Journal of Obstetrics & Gynecology, 226, 366-378. https://doi.org/10.1016/j.ajog.2021.11.1357
[29]
Lees, C.C., Stampalija, T., Baschat, A., Da Silva Costa, F., Ferrazzi, E., Figueras, F., et al. (2020) ISUOG Practice Guidelines: Diagnosis and Management of Small-for-Gestational-Age Fetus and Fetal Growth Restriction. Ultrasound in Obstetrics & Gynecology, 56, 298-312. https://doi.org/10.1002/uog.22134
[30]
Lees, C.C., Marlow, N., Van Wassenaer-Leemhuis, A., Arabin, B., Bilardo, C.M., Brezinka, C., et al. (2015) 2 Year Neurodevelopmental and Intermediate Perinatal Outcomes in Infants with Very Preterm Fetal Growth Restriction (TRUFFLE): A Randomised Trial. The Lancet, 385, 2162-2172.
https://doi.org/10.1016/S0140-6736(14)62049-3
