Related Experiment Video
Updated: Jun 27, 2025
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
Long-term neurological outcomes of offspring misdiagnosed with fetal growth restriction
Amir Snir1, Omri Zamstein2, Tamar Wainstock3
1The Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, POB 151, Beer-Sheva, IL, Israel. amsnir@gmail.com.
Insights
Misdiagnosing fetal growth restriction (FGR) in pregnant individuals is linked to a higher risk of neurological issues in children. This study highlights the importance of accurate FGR diagnosis for long-term infant health outcomes.
Area of Science:
- Perinatal Medicine
- Pediatric Neurology
- Diagnostic Accuracy
Background:
- Fetal growth restriction (FGR) significantly impacts perinatal outcomes.
- Current FGR diagnostic criteria (estimated fetal weight <10th percentile) may misclassify appropriate for gestational age (AGA) fetuses.
- Accurate diagnosis is crucial for predicting long-term infant health.
Purpose of the Study:
- To investigate the association between antepartum misdiagnosis of FGR and long-term neurological outcomes in offspring.
- To determine if falsely diagnosing AGA infants as FGR increases their risk of neurological morbidities.
- To provide evidence for refining FGR diagnostic practices.
Main Methods:
- Population-based cohort analysis of deliveries between 1991-2020.
- Comparison of neurological hospitalizations in childhood between AGA infants falsely diagnosed with FGR and those without misdiagnosis.
- Kaplan-Meier survival curves and Cox proportional hazards models were used to analyze data and control for confounders.
Main Results:
- 324,620 AGA infants were analyzed; 3249 were falsely diagnosed with FGR.
- Infants with false FGR diagnosis showed significantly higher rates of neurological hospitalizations (OR 1.431, P<0.001).
- False FGR diagnosis remained independently associated with increased long-term neurological morbidities after adjusting for confounders (aHR 1.086, P=0.043).
Conclusions:
- Misdiagnosis of antepartum FGR is associated with an elevated risk of long-term neurological morbidities in offspring.
- This finding underscores the clinical significance of accurate FGR diagnosis.
- Further research may be warranted to explore the mechanisms underlying this association.
Objective:
Fetal growth restriction (FGR) is a major determinant of adverse short- and long-term perinatal outcomes. The current definition of FGR (estimated fetal weight measurement < 10th percentile) may lead, at times, to a false diagnosis of fetuses that are eventually born appropriate for gestational age (AGA). Our objective was to investigate the potential association between a misdiagnosis of antepartum fetal growth restriction and long-term neurological outcomes in offspring.
Study Design:
A population-based cohort analysis was performed including deliveries between the years 1991-2020 in a tertiary medical center. We compared neurological hospitalization during childhood among AGA infants falsely diagnosed as FGR versus AGA infants without a false FGR diagnosis. A Kaplan-Meier survival curve was used to assess cumulative morbidity and a Cox proportional hazards model was employed to control for confounders.
Results:
During the study period, 324,620 AGA infants met the inclusion criteria; 3249 of them were falsely classified as FGR. These offspring had higher rates of hospitalizations due to various neurological conditions, as compared to those without an FGR diagnosis (OR 1.431, 95% CI 1.278-1.608; P < 0.001). In addition, cumulative hospitalization incidence was elevated in the FGR group (log-rank P-value < 0.001). When controlling for confounders, a false FGR diagnosis remained independently associated with long-term neurological morbidities (adjusted HR 1.086, 95% CI 1.003-1.177, P = 0.043).
Conclusion:
Misdiagnosis of FGR in the antepartum period is associated with an increased risk for offspring long-term neurological morbidities.
