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Downward percentile crossing as an indicator of an adverse prenatal environment
Michelle Lampl1, Francesca Gotsch, Juan Pedro Kusanovic
1Department of Anthropology, Emory University, Atlanta, GA 30323, USA. mlampl@emory.edu
Insights
Preterm labor episodes may negatively impact fetal growth, leading to smaller birth sizes in term-delivered infants. This suggests preterm labor can indicate a compromised prenatal environment affecting fetal development.
Area of Science:
- Perinatal medicine
- Maternal-fetal medicine
- Neonatal health
Background:
- Postnatal health issues in low birth weight infants are linked to poor fetal growth and adverse prenatal environments.
- Infant growth rates can exacerbate risks associated with poor fetal growth.
- Identifying prenatal growth restriction factors is crucial for understanding fetal development pathways.
Purpose of the Study:
- To investigate if preterm labor episodes compromise fetal growth.
- To determine the association between preterm labor and fetal growth trajectory.
Main Methods:
- Compared fetal size at second trimester and birth between uncomplicated pregnancies and those with preterm labor who delivered at term.
- Utilized ultrasound for fetal weight estimation.
- Analyzed changes in weight standard scores during the third trimester for significant centile crossing.
Main Results:
- Fetuses born at term after preterm labor showed reduced size at birth compared to their second-trimester measurements.
- These infants were 47% more likely to experience significant downward centile crossing.
- Preterm labor was associated with an increased odds ratio (1.47) of compromised fetal growth.
Conclusions:
- Preterm labor may indicate an adverse prenatal environment for neonates delivered at term.
- Clinically silent pregnancy events, like preterm labor, are understudied causes of fetal growth compromise.
- Small birth size in term infants may be an indicator of such prenatal growth restrictions.
Background:
Postnatal health sequelae of low birth weight have been attributed to 'poor fetal growth' from inferred adverse prenatal environments; risks augmented by infant growth rates. Identifying prenatal growth-restricting events is essential to clarify pathways and mechanisms of fetal growth.
Aim:
The specific aim of this investigation was to examine whether an episode of preterm labor may compromise fetal growth.
Subjects And Methods:
Fetal size at the end of the second trimester and birth were compared among women with uncomplicated pregnancies (n = 3167) and those who experienced an episode of preterm labor (<37 weeks) and subsequently delivered at term (> or =37 weeks, n = 147). Fetal weight estimated from ultrasound measures, and changes in weight standard scores across the third trimester investigated significant centile crossing (>0.67 standard deviation score change).
Results:
Fetuses delivered at term after an episode of preterm labor were smaller at birth relative to their peers than at the end of the second trimester, and were 47% more likely to experience clinically significant downward centile crossing (p < 0.05) than their peers (OR 1.47, 95% CI 1.04-2.07).
Conclusion:
An episode of preterm labor may signal an adverse prenatal environment for term-delivered neonates. Epidemiologically silent events in the natural history of pregnancy are an understudied source of fetal growth compromise as inferred by small birth size among peers.
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