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Published on: June 29, 2013
Fetal growth restriction as a diagnostic criterion for preeclampsia
Soichiro Obata1, Misaki Toda1, Azusa Tochio1
1Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan.
Insights
Preeclampsia (PE) diagnosis lacks unified criteria. Including fetal growth restriction (FGR) in PE diagnosis may delay recognition of organ dysfunction, indicating a need for further research.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Perinatology
Background:
- Current diagnostic criteria for preeclampsia (PE) lack uniformity.
- There is ongoing debate regarding the inclusion of fetal growth restriction (FGR) in PE diagnostic criteria.
Purpose of the Study:
- To evaluate the adequacy of incorporating FGR into the diagnostic criteria for PE.
- To compare pregnancy outcomes in PE cases with and without FGR.
Main Methods:
- Retrospective analysis of singleton pregnancies diagnosed with PE before 34 weeks gestation.
- Patients were categorized based on the primary cause of PE diagnosis (GH with FGR vs. primary organ dysfunction).
- Subgroup analysis of PE with GH and FGR based on the presence of proteinuria or organ dysfunction.
Main Results:
- Pregnancy prolongation was longer in PE cases with gestational hypertension and isolated FGR compared to those with primary organ dysfunction.
- A significant proportion of PE cases with isolated FGR later developed proteinuria or organ dysfunction.
- No significant difference in pregnancy prolongation was observed from organ dysfunction onset to delivery between subgroups.
Conclusions:
- The onset of organ dysfunction may be a more accurate indicator of PE progression than FGR onset.
- Further research is required to determine the optimal inclusion of FGR in PE diagnostic criteria.
Objectives:
Currently, no unified set of criteria to classify preeclampsia (PE) exists. Further, no consensus has been reached whether fetal growth restriction (FGR) should be included in diagnostic criteria for PE. We examined the adequacy of including FGR in diagnostic criteria for PE.
Study Design:
Singleton pregnancy patients who developed PE before 34 weeks of gestation managed at a tertiary center between 2010 and 2016 were included. Patients were divided into two groups according to cause for PE diagnosis. In addition, those diagnosed with PE because of gestational hypertension (GH) and FGR were divided into two groups according to presence of proteinuria or organ dysfunction during the expectant management.
Main Outcome Measures:
Pregnancy prolongation from PE diagnosis.
Results:
Of 69 PE patients, 18 (28.1%) were diagnosed as PE with GH and only FGR (F group). Pregnancy prolongation between PE diagnosis to delivery was longer in the F group than in PE cases with primary organ dysfunction (P group) (21 vs 10 days, P = 0.049). Of 18 patients in the F group, 12 (66.7%) subsequently had proteinuria or organ dysfunction (S group). The remaining 6 patients (33.3%) had no subsequent proteinuria or organ dysfunction (N group). There were no significant differences in prolongation of pregnancy from organ dysfunction onset to delivery between the S and P groups (10 vs 10 days, P = 0.36).
Conclusions:
Organ dysfunction onset may reflect PE progression more accurately than FGR onset. Further investigations on whether to include FGR into the diagnostic criteria for PE are needed.
