Poor Effectiveness of Antenatal Detection of Fetal Growth Restriction and Consequences for Obstetric Management and Neonatal Outcomes

Monier, Isabelle; Blondel, Béatrice; Ego, Anne; Kaminiski, M.; Goffinet, François; Zeitlin, Jennifer

doi:10.1097/01.ogx.0000469199.60232.5e

Cited by 45 publications

(83 citation statements)

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“…Unsuspected and undiagnosed SGA fetuses are common . Being SGA incurs a threefold to fourfold increased risk of stillbirth, with double the risk for undetected SGA cases compared with their detected counterparts .…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, improved identification of FGR has been listed as a top 10 priority to reduce stillbirth . It is unfortunate, and perhaps unappreciated, that the overwhelming majority of growth‐restricted fetuses are missed during pregnancy . In the large UK study, 82% of the growth‐restricted stillbirth cases were not detected antenatally …”

Section: Introductionmentioning

confidence: 99%

“…The sensitivity of universal ultrasound may be even lower in clinical practice though compared with research settings. Universal third trimester ultrasound, routinely offered in France, identified only 22% of cases of SGA . Despite a low false‐positive rate of only 2%, perinatal outcomes in France were not seen to be improved for SGA fetuses identified by universal ultrasound due to an increase in iatrogenic preterm delivery among screen positive pregnancies .…”

Section: Introductionmentioning

confidence: 99%

“…Universal third trimester ultrasound, routinely offered in France, identified only 22% of cases of SGA . Despite a low false‐positive rate of only 2%, perinatal outcomes in France were not seen to be improved for SGA fetuses identified by universal ultrasound due to an increase in iatrogenic preterm delivery among screen positive pregnancies . Given modest sensitivity, sheer costs, and potential for harm with universal ultrasound, it is uncertain whether this should be considered standard of care.…”

Section: Introductionmentioning

confidence: 99%

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Blood‐based biomarkers in the maternal circulation associated with fetal growth restriction

et al. 2019

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Fetal growth restriction (FGR) is associated with threefold to fourfold increased risk of stillbirth. Identifying FGR, through its commonly used surrogate-the small-forgestational-age (SGA, estimated fetal weight and/or abdominal circumference <10th centile) fetus-and instituting fetal surveillance and timely delivery decrease stillbirth risk. Methods available to clinicians for antenatal identification of SGA fetuses have surprisingly poor sensitivity. About 80% of cases remain undetected.Measuring the symphysis-fundal height detects only 20% of SGA fetuses, and even universal third trimester ultrasound detects, at best, 57% of those born SGA. There is an urgent need to find better ways to identify this at-risk cohort. This review summarises efforts to identify molecular biomarkers (proteins, metabolites, or ribonucleic acids) that could be used to better predict FGR. Most studies examining potential biomarkers to date have utilised case-control study designs without proceeding to validation in independent cohorts. To develop a robust test for FGR, large prospective studies are required with a priori validation plans and cohorts. Given that current clinical care detects 20% of SGA fetuses, even a screening test with ≥60% sensitivity at 90% specificity could be clinically useful, if developed. This may be an achievable aspiration. If discovered, such a test may decrease stillbirth.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Blood‐based biomarkers in the maternal circulation associated with fetal growth restriction

et al. 2019

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“…Smallness for gestational age (SGA) was defined as a birth weight lower than the tenth percentile for gestational age and sex according to Japanese reference standards. Severe SGA was defined as birth weight lower than the third percentile …”

Section: Methodsmentioning

confidence: 99%

Cytokine profiles in maternal serum are candidates for predicting an optimal timing for the delivery in early‐onset fetal growth restriction

et al. 2020

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Objective: We examined whether maternal serum cytokine profiles of mothers with early-onset fetal growth restriction (FGR) were associated with delivery within 2 weeks after sampling during the third trimester. Study design: This exploratory prospective cross-sectional study included a total of 20 singleton fetuses with early-onset FGR and 31 healthy controls. Maternal serum samples during the early third trimester were analyzed for 23 cytokines.Results: Of 20 fetuses with early-onset FGR, 14 had delivery within 2 weeks after sampling. Multivariate analysis revealed that maternal serum concentrations of soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and soluble CD40 ligand (sCD40L) were independently associated with delivery within 2 weeks in early-onset FGR. Among cases of early-onset FGR, concentrations of almost all maternal serum cytokines were similar. Maternal serum sVEGFR-1 concentrations were high when delivery occurred within 2 weeks. Maternal serum sCD40L concentrations were elicited only in cases in which delivery within 2 weeks occurred due to fetal deterioration. Conclusion:We identified two biomarkers, one specific for FGR and the other dependent on severity, that were significant components of angiogenic activities and inflammation factors. Imbalances in serum protein expression may have a substantial effect on the pathogenesis of FGR.

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Application of Prospect Theory in Obstetrics by Evaluating Mode of Delivery and Outcomes in Neonates Born Small or Appropriate for Gestational Age

Michaeli

Rozitzky

et al. 2022

JAMA Netw Open

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IMPORTANCEAntenatal diagnosis of fetal weight is challenging, and the detection rate of fetal growth restriction (FGR) is low. Neonates with FGR are known to have an increased rate of obstetric intervention during labor, but the association of antenatal fetal weight estimation with mode of delivery and neonatal outcomes among neonates who are small and appropriate for gestational age (SGA and AGA) has not been reported. OBJECTIVE To evaluate the association of antenatal fetal weight estimation with mode of delivery and neonatal outcomes among neonates who are SGA and AGA, applying psychological concepts of cognitive bias and prospect theory to a model of clinical behavior. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted between 2019 and 2020 using data from 2006 to 2018 at a tertiary care center in Jerusalem, Israel. Participants were 100 198 term singleton neonates without anomalies who were categorized into 4 groups according to the presence of an antenatal suspicion of FGR and final birth weight. Neonates with false positives (FPs;ie, group 1-FP: those with suspected FGR who were AGA) and neonates with true positives (TPs; ie, group 2-TP: those with suspected FGR who were SGA) were compared with neonates with AGA antenatal fetal weight estimation, including neonates with false negatives (FNs; ie, group 3-FN: those not suspected to have FGR who were SGA) and neonates with true negatives (TNs; ie, group 4-TN:those not suspected to have FGR who were AGA). Data were analyzed from July 2019 to July 2020. EXPOSURES Fetal weight estimation was performed according to sonographic and clinical evaluation at admission to labor, with FGR defined as a birth weight less than the 10th percentile for gestational age. Sonographic fetal weight estimation was performed according to Hadlock formula.Clinical weight estimation was performed by trained obstetricians. MAIN OUTCOMES AND MEASURESThe primary outcomes were obstetric intervention and mode of delivery; the secondary outcomes were neonatal Apgar score (with low Apgar score defined as <7) and neonatal intensive care unit (NICU) admission rates. RESULTS Among 100 198 neonates eligible for the study (50941 [50.8%] male neonates), there were 5671 neonates in group 1-FP, 3040 neonates in group 2-TP, 8508 neonates in group 3-FN, and 82 979 neonates in group 4-TN. Mean (SD) maternal age was 28.6 (5.7) years. Among 8711 neonates with suspected FGR, 34.9% were below the 10th percentile at birth, while 65.1% were AGA.Neonates with suspected FGR had a significantly increased rate of induction of labor (group 1-FP: 649 neonates [11.4%] and group 2-TP: 969 neonates [31.9%]) compared with neonates in group 3-FN (1055 neonates [12.4%]) and group 4-TN (7136 neonates [8.6%]) (P < .001) and a significantly increased rate of cesarean delivery (group 1-FP: 915 neonates [16.1%] and group 2-TP: 556 neonates [18.3%] vs group 3-FN: 1106 neonates [13.0%] and group 4-TN: 6588 neonates [7.9%]; P < .001).Increased NICU admission was found for neonates who were SGA compared with neona...

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Poor Effectiveness of Antenatal Detection of Fetal Growth Restriction and Consequences for Obstetric Management and Neonatal Outcomes

Cited by 45 publications

References 0 publications

Blood‐based biomarkers in the maternal circulation associated with fetal growth restriction

Blood‐based biomarkers in the maternal circulation associated with fetal growth restriction

Cytokine profiles in maternal serum are candidates for predicting an optimal timing for the delivery in early‐onset fetal growth restriction

Application of Prospect Theory in Obstetrics by Evaluating Mode of Delivery and Outcomes in Neonates Born Small or Appropriate for Gestational Age

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