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Respiratory morbidity among offspring misclassified as growth restricted

Omri Zamstein1, Tamar Wainstock2, Eyal Sheiner1

  • 1Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Pediatric Pulmonology
|March 13, 2024
PubMed

Insights

Misclassifying fetuses as small for gestational age (FGR) increases their risk of childhood respiratory issues like asthma. This highlights the need for accurate prenatal diagnostics to avoid unnecessary interventions and protect long-term infant health.

Area of Science:

  • Perinatal medicine
  • Pediatric respiratory health
  • Diagnostic accuracy in obstetrics

Background:

  • Ultrasound-based fetal growth restriction (FGR) diagnosis can misclassify appropriately grown fetuses (AGA).
  • Misclassification may lead to unnecessary interventions like early labor induction.
  • Long-term health outcomes, particularly respiratory health, of these misclassified infants are not well understood.

Purpose of the Study:

  • To evaluate the long-term respiratory health of offspring misclassified as FGR.
  • To compare respiratory morbidity incidence in AGA newborns with and without a false FGR diagnosis.

Main Methods:

  • Population-based cohort analysis of AGA singletons (1991-2021) at a tertiary hospital.
  • Comparison of respiratory morbidity incidence between misclassified FGR and non-FGR AGA newborns.
  • Kaplan-Meier survival analysis and stratified Cox proportional-hazards models for morbidity incidence and confounder control.

Main Results:

  • 1.0% (3249/324,620) of AGA newborns were misclassified as FGR.
  • Misclassified FGR infants had earlier delivery (36.7 vs. 39.1 weeks) and >25% higher childhood respiratory morbidity (33.2% vs. 26.5%).
  • Increased risk of asthma and obstructive sleep apnea was observed, independent of preterm birth and other factors (aHR=1.14).

Conclusions:

  • Appropriately grown newborns misclassified as FGR face a significantly increased risk of long-term respiratory morbidity.
  • This includes higher incidences of asthma and obstructive sleep apnea during childhood and adolescence.
  • Accurate prenatal diagnostics are crucial to prevent unnecessary interventions and mitigate adverse respiratory outcomes.
Abstract

Keywords:
AGA offspringchildhood respiratory morbiditygrowth restriction misclassificationlong‐term respiratory healthprenatal diagnosis

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