Clinical phenotypes for risk stratification in small-for-gestational-age fetuses.

Area of Science:

• Perinatology
• Maternal-Fetal Medicine
• Neonatology

Background:

• Small-for-gestational-age (SGA) fetuses represent a significant concern in perinatal care.
• Accurate risk stratification for adverse outcomes in SGA fetuses is crucial for clinical management.
• Current methods may not fully capture the heterogeneity of SGA conditions.

Purpose of the Study:

• To identify distinct clinical phenotypes of SGA fetuses.
• To evaluate the utility of these phenotypes in stratifying risks for adverse perinatal outcomes.
• To enhance clinical decision-making in the management of SGA pregnancies.

Main Methods:

• A multicenter observational cohort study involving 17,631 singleton pregnancies.
• SGA fetuses (n=1274) were classified into phenotypes using a two-step cluster algorithm based on maternal, fetal, and placental conditions.
• Perinatal outcomes were compared across SGA phenotypes using statistical analyses, including odds ratios adjusted for gestational age.

Main Results:

• Nine distinct SGA clinical phenotypes were identified, each associated with significantly different delivery and perinatal outcomes.
• The overall SGA cohort exhibited a three-fold higher risk of perinatal mortality compared to non-SGA fetuses.
• Phenotypes associated with congenital anomalies and third-trimester hemorrhage presented the highest perinatal mortality risks, while SGA combined with gestational diabetes showed a significantly increased risk of perinatal death.

Conclusions:

• Nine SGA clinical phenotypes were identified, demonstrating varied risks for adverse perinatal outcomes.
• Integrating clinical characteristics with ultrasound findings can improve risk stratification and management decisions for SGA fetuses.
• Future research and clinical trials for SGA management should incorporate clinical information alongside traditional parameters like Doppler and estimated fetal weight.