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Intrauterine growth restriction: effects of physiological fetal growth determinants on diagnosis
Kjell Haram1, Eirik Søfteland, Radek Bukowski
1Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway.
Insights
Assessing fetal growth is crucial for pregnancy outcomes. Customized growth potential norms better identify fetal growth aberrations than population or ultrasound standards, improving risk assessment.
Area of Science:
- Perinatal Medicine
- Fetal Development
- Obstetrics
Background:
- Fetal growth assessment is vital for pregnancy outcomes, influenced by physiological and pathological factors.
- Current standards for fetal weight (birthweight or estimated fetal weight) often lack accuracy due to inaccurate gestational age estimation and failure to account for physiological determinants.
- Accurate fetal growth norms are essential for predicting and managing pregnancy complications.
Purpose of the Study:
- To evaluate the effectiveness of different fetal growth standards in predicting adverse pregnancy outcomes.
- To compare population-based, ultrasound-based, and customized fetal growth norms.
- To determine if customized growth potential norms offer superior risk discrimination for fetal growth aberrations.
Main Methods:
- Review of existing literature on fetal growth standards, including population-based birthweight norms, ultrasound-dated standards, and customized growth charts.
- Analysis of the predictive capabilities of various standards for perinatal mortality and morbidity.
- Evaluation of the impact of adjusting for individual variations in growth curves on the diagnosis of intrauterine growth restriction (IUGR).
Main Results:
- Customized standards, using early ultrasound for gestational age, show superiority over population-based birthweight norms in predicting perinatal mortality and morbidity.
- Adjusting for individual variations in customized growth curves reduces false-positive diagnoses of IUGR, potentially decreasing interventions.
- While customized charts improve risk identification, they may not effectively detect growth-restricted stillbirths.
Conclusions:
- Growth potential norms, which consider individual variations, are superior discriminators of fetal growth aberrations compared to population, ultrasound, and customized norms.
- Customized fetal growth charts offer improved prediction of adverse outcomes but have limitations in detecting certain stillbirths.
- Further research into growth potential norms may enhance the accuracy of fetal growth assessment and management.
Abstract:
The growth of the fetus, which is strongly associated with the outcome of pregnancy, reflects interplay of several physiological and pathological factors. The assessment of fetal growth is based on comparison of birthweight (BW) or estimated fetal weight (EFW) to standards which define reference ranges at a spectrum of gestational ages. Most birthweight standards do not take into account effects of physiological determinants of fetal growth. Additionally, gestational age in many standards is based on the menstrual history and is often inaccurate. Fetal growth norms should be based on an early ultrasound estimate of gestational age. Customized standards, which have included only ultrasound-dated pregnancies, seem to be superior to population-based birthweight norms in predicting perinatal mortality and morbidity. Adjustment for individual variation in customized growth curves reduces false-positive diagnosis of IUGR and may lead to a very significant reduction in intervention for suspected IUGR. Customized growth potential identifies better the risk for adverse outcome than the currently used national standards, but customized charts may fail in detecting growth-restricted stillbirth. An individual's birthweight is the sum of physiological and pathological influences operating during pregnancy. Growth potential norms are a better discriminator of aberrations of fetal growth than population, ultrasound, and customized norms.
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