Accelerated fetal growth in early pregnancy and risk of preterm birth: a prospective cohort study

Abstract

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.

Risk and Clinical Significance of Idiopathic Preterm Birth in Microvillus Inclusion Disease

“…Antenatal symptoms [28] occurred in almost onequarter of MVID cases, but were not different between the preterm and at term birth groups. Increased fetal growth has been shown to increase the risk of spontaneous late preterm birth [29,30]. Higher birth weight percentiles were observed in MVID patients who were born preterm, when compared to those born at term.…”

Epigenetic marks associated with gestational diabetes mellitus across two time points during pregnancy

“…Due to the great controversial and variety about the diagnostic criteria for GDM, there is an increasing need to establish biomarkers able to identify in early pregnancy the occurrence of GDM. Currently, the Gold Standard is made with an OGTT at around 26–28 weeks of gestation but it is known that differences in fetal growth occur even at early pregnancy (at 12 weeks) between mothers who will be diagnosed with GDM and who will be not [ 34 ]. Finding out accessible and stable biomarkers for predicting GDM would allow an early intervention and the subsequent reduction risk both in mothers and their offspring.…”