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Published on: June 29, 2013
Fetal growth restriction in rural Bangladesh: a prospective study
Farzana Ferdous1, Md Harunor Rashid1,2, Enbo Ma3,4
11Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575 Japan.
Insights
Fetal growth restriction (FGR) is prevalent in rural Bangladesh, with smaller fetal size observed in the third trimester compared to international standards. Growth faltering begins in the second trimester, highlighting challenges for nutritional interventions in this population.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Maternal-Fetal Medicine
Background:
- Fetal growth restriction (FGR) and low birth weight (LBW) are significant global health issues, particularly in developing countries.
- FGR is a primary cause of LBW in developing nations, leading to increased neonatal mortality and long-term developmental problems.
- Accurate fetal growth charts are crucial for monitoring fetal development during pregnancy.
Purpose of the Study:
- To characterize the fetal growth patterns in a rural Bangladeshi population with high rates of maternal undernutrition.
- To compare the timing of FGR in this population against established WHO and INTERGROWTH-21st international reference values.
- To identify specific biometric parameters and gestational periods affected by growth faltering.
Main Methods:
- A cohort of 2678 pregnant women in rural Bangladesh (Matlab) were recruited between November 2001 and October 2003.
- Three serial ultrasound examinations were performed during pregnancy to measure fetal head, abdomen, and femur parameters.
- Collected data were analyzed using a linear-cubic model and compared with international fetal growth reference standards.
Main Results:
- Fetal biparietal diameter and abdominal circumference growth were significantly smaller than reference values throughout pregnancy (P ≤ 0.05).
- A greater deviation from international growth charts (WHO and INTERGROWTH-21st) was observed after 28 weeks of gestation (P ≤ 0.05).
- Post-28 weeks, estimated fetal weight gain per week was significantly lower in Bangladeshi fetuses (67.4 g less than WHO estimates; P ≤ 0.001).
Conclusions:
- Fetuses in the studied Bangladeshi population were smaller in the third trimester compared to international reference charts.
- Evidence of growth faltering across all measured biometric parameters (head, abdomen, femur) was detected starting in the second trimester.
- These findings indicate significant challenges for implementing effective nutritional interventions to improve fetal growth in this population.
Background:
Fetal growth restriction (FGR) and low birth weight(LBW) are serious public health problems. In developing countries, the incidence of low birth weight is predominantly the result of FGR, and both low birth weight and FGR are associated with neonatal death and later growth and development. Fetal growth charts are important for assessing the size of the fetus during pregnancy. The aims of this study were to describe the fetal growth pattern of a population in rural Bangladesh where maternal undernutrition is prevalent and to compare the timing of FGR in that population with WHO and INTERGROWTH- 21st international reference values.
Methods:
From November 2001 to October 2003, pregnant women were recruited in Matlab, a sub district of Bangladesh, and underwent three follow-up ultrasound examinations during pregnancy for measurement of the parameters of the fetal head, abdomen, and femur. The data were fitted to a linear-cubic model, and the derived values were compared with international reference values.
Results:
A total of 2678 singleton pregnancies were included in the analyses. The mean (SD) maternal age was 25.9 (5.8) years (range, 14-47 years). The mean (SD) early pregnancy BMI was 20.1 (2.6) kg/m2, and 27.6% of the women were underweight (BMI < 18.5 kg/m2). The growth of the biparietal diameter and abdominal circumference was significantly smaller throughout the pregnancy than the reference values (P ≤ 0.05). Moreover, a larger deviation in the growth of Bangladeshi fetuses was observed after 28 weeks of gestation when compared with the WHO and INTERGROWTH-21st reference fetal growth charts (P ≤ 0.05). After 28 weeks of gestation, the average Bangladesh estimated fetal weight gain per week of gestational age was significantly lower than the WHO estimated fetal weight by as much as 67.4 g (P ≤ 0.001).
Conclusions:
The present population-based study showed that fetuses were smaller in the third trimester when compared with the reference charts. Growth faltering started in the second trimester for all the biometric parameters for the head, abdomen, and femur. This finding provides more challenges concerning nutritional interventions.
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