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Multiple fetuses, growth deviations and mortality in a very preterm birth cohort
1Children's Hospital, University of Kuopio, Finland.
Insights
Deviant fetal growth, both small and large for gestational age, significantly increases preterm infant mortality risk. This risk is even higher with multiple fetuses experiencing growth deviations, necessitating close monitoring.
Area of Science:
- Perinatal Medicine
- Neonatology
- Fetal Development
Background:
- Deviant fetal growth is a concern in preterm births.
- Understanding its impact on mortality is crucial for improving outcomes.
Purpose of the Study:
- To analyze the association between deviant fetal growth and mortality in very preterm infants.
- To investigate the impact of multiple deviant fetal growth on mortality risk.
Main Methods:
- Univariate and multivariate analyses were used.
- A cohort of 355 very preterm infants (born ≤32 weeks' gestation) was studied.
- Fetal growth norms were established from a separate singleton preterm cohort.
Main Results:
- Both small for gestational age (SGA) and large for gestational age (LGA) preterms had higher mortality than appropriately grown infants (66% and 53% vs. 35%).
- Mortality risk significantly increased when multiple fetuses exhibited deviant growth (SGA or LGA).
Conclusions:
- Deviant fetal growth is a significant risk factor for mortality in very preterm infants.
- Multiple deviant fetal growth, especially LGA, warrants intensive fetal and neonatal monitoring.
- Perinatal variables interactions are important for assessing outcomes in preterm infants.
Abstract:
The associations between deviant fetal growth and fetal to 1st year mortality were analysed using univariate and multivariate techniques in a very preterm birth cohort (N = 355; 285 live births; 70 stillbirths) born at or before 32 weeks' gestation in the province of Kuopio, Finland, in 1978-86. Regional fetal growth norms were obtained from non-malformed preterm singletons live-born during a separate five-year period to mothers without chronic diseases or pregnancy complications. Both small and large for gestational age preterms (SGAs and LGAs) showed significantly higher fetal to 1st year mortality (66% and 53%, respectively) than the appropriately-grown group (35%). However, the mortality risk increased markedly if deviant growth (either SGA or, in particular, LGA) was present in multiple fetuses. In such cases, careful follow-up of fetal and neonatal well-being is indicated through the remaining perinatal period. Interactions between perinatal variables should also be taken into account as determinants of outcome both in interventional studies and quality assessments of the care of mid-pregnancy fetuses and preterm infants.