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[Fetal growth retardation: prevention. Review of the literature]
P Boulot1, P L Giacalone, B Hedon
1Service de Gynécologie-Obstétrique, CHRU Montpellier, Faculté de Médecine, Université Montpellier I.
Insights
Preventive treatment for fetal intrauterine growth retardation requires risk identification and early screening. Aspirin shows promise by restoring prostaglandin balance, but further research is needed for other therapies.
Area of Science:
- Obstetrics and Gynecology
- Perinatology
- Pharmacology
Context:
- Fetal intrauterine growth retardation (IUGR) necessitates effective preventive strategies.
- Risk stratification involves obstetric history, biological markers, and Doppler flowmetry.
- Current preventive measures require further validation through controlled studies.
Purpose:
- To review current and potential preventive treatments for fetal IUGR.
- To evaluate the efficacy and indications for aspirin in IUGR prevention.
- To explore novel therapeutic avenues, including Beta-Mimetics, oxygen therapy, and immunomodulation.
Summary:
- Aspirin's preventive role in IUGR is explored due to its ability to re-establish prostaglandin balance.
- Clinical effects and safety of aspirin have been studied, but controlled trials are lacking.
- Other potential prophylactics like Beta-Mimetics, maternal oxygen therapy, and gammaglobulin transfusions show promise but require more evidence.
Impact:
- Highlights the need for evidence-based preventive strategies for fetal IUGR.
- Identifies aspirin as a potential therapeutic agent, warranting further investigation.
- Suggests promising research directions in immunomodulatory treatments for IUGR prevention.
Abstract:
The principle underlying preventive treatment of fetal intrauterine growth retardation can only be considered after defining various groups that are at risk and early screening based on the obstetric history, biological tests, and recently using flow rates with Doppler techniques. The use of aspirin in preventive treatment of growth retardation originates in the pharmacological properties of its molecule which allow the re-establishment of a balance of the prostoglandins. Numerous authors have studied clinical effects, its harmlessness as well as the true indications for its use. As there have been no control studies the theoretical possibilities of using Beta-Mimetic drugs has not been tested. The use of ultrasound has made it possible to try to see whether there is an improvement in the fetal state of well-being when oxygen therapy is used by the mother as it is in certain extremes to see what effect it has on placental function. Its use as an effective prophylactic has not yet been demonstrated. Promising lines of research could be assessing the effects of immunological treatments that have already been suggested (especially gammaglobulin transfusions). They have been used prophylactically with success but the series are small for well defined immunological indications.