Why we succeed and fail in detecting fetal growth restriction: A population-based study

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Healthcare Management

Background:

• Fetal growth restriction (FGR) affects approximately 3.9% of pregnancies.
• Antenatal detection of FGR remains a challenge, impacting perinatal outcomes.
• Factors influencing FGR detection include maternal, healthcare provider, and organizational elements.

Purpose of the Study:

• To investigate associations between the detection of fetal growth restriction and maternal, healthcare provider, and organizational factors.
• To identify predictors for antenatal detection of FGR.
• To explore potential disparities in FGR detection rates.

Main Methods:

• A historical, observational, multicenter study included women with FGR (birthweight <2.3rd centile) in Zealand, Denmark (2012-2015).
• Data were extracted from the Danish Fetal Medicine Database and medical charts, including maternal characteristics and healthcare professional information.
• Multivariable Cox regression models were employed to identify predictors of antenatal FGR detection, adjusting for various covariates.

Main Results:

• Detection of FGR occurred in 31% of affected pregnancies.
• Increased clinical experience of the primary consulting midwife was positively associated with FGR detection (HR 1.15 per 10 years).
• Higher numbers of midwife consultations (HR 1.15) and multiparity (HR 1.28) were linked to increased detection rates, with significant unexplained hospital-level differences (P=.01).

Conclusions:

• Low-risk nulliparous women may be an underdiagnosed group for FGR.
• Enhanced screening by experienced midwives early in pregnancy and increased consultation frequency could improve FGR diagnosis.
• Addressing organizational factors and ensuring continuity of care are crucial for optimizing antenatal FGR detection.