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Published on: June 29, 2013
Interaction between risk factors for fetal growth retardation associated with abnormal umbilical artery Doppler
Arsenio Spinillo1, Carola Bergante, Barbara Gardella
1Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico S.Matteo, Piazzale Golgi 2, 27100 Pavia, Italy. spinillo@smatteo.pv.it
Insights
Antenatal risk factors like preeclampsia, smoking, and low weight gain increase the risk of fetal growth restriction with abnormal umbilical artery Doppler studies. These factors are crucial in understanding abnormal uteroplacental blood flow.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Fetal Physiology
Background:
- Fetal growth restriction (FGR) with abnormal umbilical artery Doppler studies is a significant concern in high-risk pregnancies.
- The specific antenatal risk factors and their interactions contributing to FGR with abnormal umbilical artery end-diastolic velocities require further investigation.
Purpose of the Study:
- To evaluate the role of antenatal risk factors in the development of fetal growth restriction (FGR).
- To examine the interactions between these risk factors and abnormal umbilical artery Doppler studies, specifically absent/reversed end-diastolic blood flow.
Main Methods:
- A comparative study involving 183 pregnancies with FGR and abnormal umbilical artery Doppler studies.
- Control group comprised 549 pregnancies with appropriately grown fetuses and normal umbilical artery Doppler findings.
- Logistic regression analysis was employed to assess associations and interactions of antenatal variables.
Main Results:
- Maternal age, nulliparity, smoking, preeclampsia, first-trimester hemorrhage, and low pregnancy weight gain were significantly associated with increased risk of FGR and abnormal Doppler.
- Preeclampsia demonstrated a strong association (OR 27.5), as did smoking (OR 2.56) and low weight gain (OR 3.48).
- Interactions were observed: maternal smoking had a negative interaction with preeclampsia but a positive interaction with low weight gain.
Conclusions:
- Antenatal risk factors for FGR with abnormal Doppler studies are similar to those for small-for-gestational-age infants.
- Preeclampsia, maternal smoking, and inadequate weight gain are key contributors to FGR with abnormal uteroplacental blood flow.
- Understanding these factors is vital for improved antenatal surveillance and management of high-risk pregnancies.
Background:
The role of antenatal risk factors associated with the occurrence of fetal growth restriction complicated by abnormal umbilical artery Doppler studies has not yet been studied extensively. We evaluated the role and the interactions of antenatal antecedents of fetal growth restriction complicated by abnormal umbilical artery end-diastolic velocities.
Methods:
We compared antenatal variables in 183 pregnancies complicated by fetal growth retardation and abnormal umbilical artery Doppler studies and 549 appropriately grown fetuses with normal end-diastolic velocity waveform in the umbilical artery. Logistic regression was used to evaluate the association between antenatal variables and fetal growth retardation and to test for interaction.
Results:
In logistic models, increasing maternal age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.01-1.11], nulliparity (OR 2.2, 95% CI 1.37-3.5), smoking during pregnancy (OR 2.56, 95% CI 1.56-4.22), preeclampsia (OR 27.5, 95% CI 15.1-49.9), first-trimester hemorrhage (OR 2.25, 95% CI 1.32-3.82) and low (< 0.2 kg/week) weight gain in pregnancy (OR 3.48, 95% CI 1.71-3.05) were significantly associated with an increased risk of fetal growth restriction complicated by abnormal Doppler studies. These risk factors were also significantly correlated with the occurrence of absent/reversed end-diastolic blood flow in the umbilical artery. Maternal smoking during pregnancy interacted negatively with preeclampsia but positively with a low weight gain in pregnancy.
Conclusions:
The results of this study have shown that antenatal risk factors for intrauterine growth retardation (IUGR) complicated by abnormal Doppler studies are similar to those associated with the birth of a small-for-gestational-age infant. Preeclampsia, maternal smoking and low weight gain in pregnancy play a significant causal role in the origin of fetal growth restriction associated with abnormal uteroplacental blood flow.
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