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Published on: June 29, 2013
Accelerated fetal growth in early pregnancy and risk of preterm birth: a prospective cohort study
Evangelia Elenis1, Anna-Karin Wikström2, Marija Simic3
1Department of Children's and Women's Health, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. evangelia.elenis@kbh.uu.se.
Insights
Accelerated fetal growth in early pregnancy, measured by biparietal diameter (BPD), is linked to an increased risk of preterm birth. This finding highlights the importance of early fetal growth assessment for predicting prematurity.
Area of Science:
- Obstetrics and Gynecology
- Fetal Medicine
- Neonatology
Background:
- Preterm birth affects 15 million infants globally, causing significant mortality.
- Early detection and diagnosis of prematurity risk are crucial for prevention.
- Previous research focused on reduced fetal growth; this study examines accelerated growth.
Purpose of the Study:
- To investigate the association between accelerated fetal growth in early pregnancy and the risk of preterm birth.
- To analyze the impact of early pregnancy fetal growth on different types of preterm birth.
Main Methods:
- Prospective cohort study of 69,617 singleton pregnancies.
- Fetal growth estimated using biparietal diameter (BPD) measurements from first and second trimester scans.
- Analysis of association between accelerated BPD growth and preterm birth (<37 weeks), including very preterm (<32 weeks) and moderate preterm (32-37 weeks) births.
Main Results:
- Accelerated BPD growth (>90th centile) between scans increased prematurity odds (aOR 1.36).
- This association was significant for moderate preterm births but not very preterm births.
- Accelerated growth was linked to higher odds of medically induced preterm birth (aOR 1.34), while delayed growth showed lower odds for overall and spontaneous preterm birth.
Conclusions:
- Accelerated fetal BPD growth in early pregnancy, detected via ultrasound, is associated with increased odds of preterm birth.
- Early pregnancy fetal growth assessment is a valuable factor in predicting preterm birth risk.
- Findings suggest a shift in focus towards early pregnancy growth patterns for prematurity risk assessment.
Background:
Preterm birth (occurring before 37 completed weeks of gestation) affects 15 million infants annually, 7.5% of which die due to related complications. The detection and early diagnosis are therefore paramount in order to prevent the development of prematurity and its consequences. So far, focus has been laid on the association between reduced intrauterine fetal growth during late gestation and prematurity. The aim of the current study was to investigate the association between accelerated fetal growth in early pregnancy and the risk of preterm birth.
Methods:
This prospective cohort study included 69,617 singleton pregnancies without congenital malformations and with available biometric measurements during the first and second trimester. Estimation of fetal growth was based on measurements of biparietal diameter (BPD) at first and second trimester scan. We investigated the association between accelerated fetal growth and preterm birth prior to 37 weeks of gestation. The outcome was further stratified into very preterm birth (before 32 weeks of gestation) or moderate preterm birth (between 32 and 37 weeks of gestation) and medically induced or spontaneous preterm birth and was further explored.
Results:
The odds of prematurity were increased among fetuses with accelerated BPD growth (> 90th centile) estimated between first and second ultrasound scan, even after adjustment for possible confounders (aOR 1.36; 95% CI 1.20-1.54). The findings remained significant what regards moderate preterm births but not very preterm births. Regarding medically induced preterm birth, the odds were found to be elevated in the group of fetuses with accelerated growth in early pregnancy (aOR 1.34; 95% CI 1.11-1.63). On the contrary, fetuses with delayed fetal growth exhibited lower odds for both overall and spontaneous preterm birth.
Conclusions:
Fetuses with accelerated BPD growth in early pregnancy, detected by ultrasound examination during the second trimester, exhibited increased odds of being born preterm. The findings of the current study suggest that fetal growth in early pregnancy should be taken into account when assessing the risk for preterm birth.
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