First-trimester fetal growth restriction and the occurrence of miscarriage in rural Bangladesh: A prospective cohort study

Abstract

Fetal growth restriction in early pregnancy increases the risk of adverse pregnancy outcome, which has a significant social and psychological impact on women. There is limited information related to community-based study to evaluate early indicators related to miscarriage. The aim of this study is to examine the relationship between fetal growth restriction, measured by ultrasound crown-rump length (CRL), and subsequent occurrence of miscarriage in pregnant women in rural Bangladesh. The study was conducted within the Maternal and Infant Nutrition Interventions Trial in Matlab (MINIMat study), Bangladesh. A total of 4436 pregnant women were enrolled in the study when they were at less than 14 gestational weeks. The expected CRL was determined based on an established growth curve of gestational age and CRL, and deviation from this curve of CRL was expressed as a z-score. After identifying related covariates, the multiple Poisson regression model was used to determine the independent contribution from the CRL to miscarriage. A total of 3058 singleton pregnant women were included in analyses, with 92 miscarriages and 2966 continued pregnancies. The occurrence of miscarriages was significantly higher in the smaller categories of CRL z-score after adjustments for maternal age, parity, early pregnancy BMI, gestational age at CRL measurement and socioeconomic status (adjusted relative risk [95% confidence interval]: 1.03 [1.02–1.05] for less than -2 z-score). In a rural Bangladesh population, smaller than expected CRL for the gestational age was related to subsequent miscarriage. Ultrasound biometry information together with careful clinical assessment should provide much needed attention and care for pregnant women.

Factors associated with spontaneous abortion: a systematic review

“…This association can be explained by the various endocrine and metabolic changes, such as altered secretion and ineffective action of insulin, leptin, resistin, ghrelin, in addition to changes in the metabolism of steroids that can lead to spontaneous abortion. 5,9,11,16,21,22 In contrast, this association has not been found in other studies, 9,18,20 which noticed increased fertility in obese women. However, the chance of miscarriage in these women was also greater than in eutrophic women.…”

“…10 A 5-year increase in maternal age increases the risk of miscarriage 1.5 times. 5,11,12,13 However, some studies have noticed a contrary association. 1,[14][15][16][17][18] One explanation for this divergence lies in the fact that the studies that associated the maternal age above 35 years of age with abortion were performed in developed countries, where women are likely to become pregnant at an older age; and studies that address maternal age below 35 as a risk factor have been carried out in developing countries, where women become pregnant earlier, increasing the likelihood of miscarriage.…”

“…Due to its continental dimension, these data may vary in relation to the regional context, and the lower access to health information and services is also related to the low income of women. 11,20,21 Regarding the risk factors for spontaneous abortion related to health status, there is an increase in body weight, characterized by overweight and obesity. This association can be explained by the various endocrine and metabolic changes, such as altered secretion and ineffective action of insulin, leptin, resistin, ghrelin, in addition to changes in the metabolism of steroids that can lead to spontaneous abortion.…”

Smaller than expected crown-rump length ultrasound measurements in 1st-trimester pregnancy: does it have any risk of subsequent pregnancies?

“…A recent study from Bangladesh also reported a vitalrelationship between negative CRL z-score categories and the probability of miscarriage. 12 The mean maternal age was also significantly higher (30.50 vs 25.74, p-value< 0.01) in the miscarried group than in the continued pregnancy group. Significant differences were found between the maternal age groups (p-value<0.01).…”

Testing the Limit: Evaluating Drinking Water Arsenic Regulatory Levels Based on Adverse Pregnancy Outcomes in Bangladesh

“…Yasmin et al in Bangladesh, showed that low birth weight accompanied by preterm birth resulted in 75% of the neonatal mortality, of which 84% occurred 0 to 6 days post birth [ 20 ]. Studies that have examined the rate of miscarriage in Bangladesh have identified other risk factors including lower socioeconomic status, short birth spacing between pregnancies, and mothers aged over 35 years [ 19 , 22 ]. Furthermore, many epidemiological studies on arsenic-related health effects have been conducted in the past two decades.…”