Growth restriction in gastroschisis: quantification of its severity and exploration of a placental cause

Abstract

BackgroundGastroschisis patients are commonly small for gestational age (SGA, birth weight [BW] < 10th centile). However, the extent, symmetry and causes of that growth restriction remain controversial.MethodsWe compared BW, crown-heel length (LT), occipitofrontal circumference (OFC) and ponderal index (PI) in 179 gastroschisis cases and 895 matched controls by univariate and multiple regression. Fetal ultrasounds (N = 80) were reviewed to determine onset of growth restriction. Placental histology was examined in 31 gastroschisis patients whose placental tissue was available and in 29 controls.ResultsGastroschisis cases weighed less than controls (BW = 2400 ± 502 g vs. 2750 ± 532 g, p < 0.001) and their BW frequency curve was shifted to the left, indicating lower BW as a group compared to controls (p < 0.001 by Kolmogorov-Smirnov test). BW differences varied from -148 g at 33 weeks to -616 g at 38 weeks gestation. Intrauterine growth restriction was symmetric with gastroschisis patients having a shorter LT (45.7 ± 3.3 vs. 48.4 ± 2.7 cm, p < 0.001), smaller OFC (31.9 ± 1.9 vs. 32.9 ± 1.6 cm, p < 0.001), but larger ponderal index (2.51 ± 0.37 vs. 2.40 ± 0.16, p < 0.001) compared to controls. Gastroschisis patients had a similar reduction in BW (-312 g, 95% confidence interval [CI] = -367, -258) compared to those with chromosomal abnormalities (-239 g, CI = -292, -187). Growth deficits appeared early in the second trimester and worsened as gestation increased. Placental chorangiosis was more common in gastroschisis patients than controls, even after removing all SGA patients (77% vs. 42%, p = 0.02).ConclusionsMarked, relatively symmetric intrauterine growth restriction is an intrinsic part of gastroschisis. It begins early in the second trimester, and is associated with placental chorangiosis.

Fetal Growth Pattern and Prediction of Low Birth Weight in Gastroschisis

“…1). This HC/AC ratio pattern suggests symmetrical growth impairment in these fetuses, as has been observed in previous studies [7]. …”

“…Because signs of fetal growth impairment were described as early as in the early second trimester [7,9,18], it is most likely that the mechanisms involved are present and active since the early stages of pregnancy. …”

“…Gastroschisis is one of the congenital malformations associated with the lowest birth weight [7]. Impaired intrauterine growth and low birth weight are common findings in fetal gastroschisis.…”

“…Two studies demonstrated that growth impairment in fetuses with gastroschisis begins in the middle of the second trimester [7,9]. Not only is the abdominal circumference (AC) small due to bowel herniation, but other biometric parameters are also altered.…”

“…Fetal hypoproteinemia secondary to protein loss across the bowel wall exposed to amniotic fluid, bowel inflammation, placental chorangiosis, villous edema and fetal hypoxia are mechanisms potentially related to the increased rate of intrauterine fetal growth restriction in fetal gastroschisis [7,8]. …”