Practice variation in diagnosis, monitoring and management of fetal growth restriction in the Netherlands

Marijnen, Mauritia C.; Damhuis, Stefanie Elisabeth; Smies, Maddy; Gordijn, Sanne J.; Ganzevoort, Wessel

doi:10.1016/j.ejogrb.2022.07.021

Cited by 4 publications

(3 citation statements)

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“…Even babies born with a normal range birthweight could suffer from FGR, which can lead to increased risk of perinatal mortality and morbidity ( De Reu et al , 2010 ; Audette and Kingdom, 2018 ). FGR is commonly defined as a condition in which the fetus does not reach its intrinsic growth potential ( Marijnen et al , 2022 ). Placental insufficiency, resulting from a variety of placental lesions, is the common underlying pathophysiologic mechanism ( Burton and Jauniaux, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Obstetric and neonatal outcomes after natural versus artificial cycle frozen embryo transfer and the role of luteal phase support: a systematic review and meta-analysis

Zaat,

Kostova,

Korsen

et al. 2023

Human Reproduction Update

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BACKGROUND The number of frozen embryo transfers (FET) has increased dramatically over the past decade. Based on current evidence, there is no difference in pregnancy rates when natural cycle FET (NC-FET) is compared to artificial cycle FET (AC-FET) in subfertile women. However, NC-FET seems to be associated with lower risk of adverse obstetric and neonatal outcomes compared with AC-FET cycles. Currently, there is no consensus about whether NC-FET needs to be combined with luteal phase support (LPS) or not. The question of how to prepare the endometrium for FET has now gained even more importance and taken the dimension of safety into account as it should not simply be reduced to the basic question of effectiveness. OBJECTIVE AND RATIONALE The objective of this project was to determine whether NC-FET, with or without LPS, decreases the risk of adverse obstetric and neonatal outcomes compared with AC-FET. SEARCH METHODS A systematic review and meta-analysis was carried out. A literature search was performed using the following databases: CINAHL, EMBASE, and MEDLINE from inception to 10 October 2022. Observational studies, including cohort studies, and registries comparing obstetric and neonatal outcomes between singleton pregnancies after NC-FET and those after AC-FET were sought. Risk of bias was assessed using the ROBINS-I tool. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. We calculated pooled odds ratios (ORs), pooled risk differences (RDs), pooled adjusted ORs, and prevalence estimates with 95% CI using a random effect model, while heterogeneity was assessed by the I2. OUTCOMES The conducted search identified 2436 studies, 890 duplicates were removed and 1546 studies were screened. Thirty studies (NC-FET n = 56 445; AC-FET n = 57 231) were included, 19 of which used LPS in NC-FET. Birthweight was lower following NC-FET versus AC-FET (mean difference 26.35 g; 95% CI 11.61–41.08, I2 = 63%). Furthermore NC-FET compared to AC-FET resulted in a lower risk of large for gestational age (OR 0.88, 95% 0.83–0.94, I2 = 54%), macrosomia (OR 0.81; 95% CI 0.71–0.93, I2 = 68%), low birthweight (OR 0.81, 95% CI 0.77–0.85, I2 = 41%), early pregnancy loss (OR 0.73; 95% CI 0.61–0.86, I2 = 70%), preterm birth (OR 0.80; 95% CI 0.75–0.85, I2 = 20%), very preterm birth (OR 0.66, 95% CI 0.53–0.84, I2 = 0%), hypertensive disorders of pregnancy (OR 0.60, 95% CI 0.50–0.65, I2 = 61%), pre-eclampsia (OR 0.50; 95% CI 0.42–0.60, I2 = 44%), placenta previa (OR 0.84, 95% CI 0.73–0.97, I2 = 0%), and postpartum hemorrhage (OR 0.43; 95% CI 0.38–0.48, I2 = 53%). Stratified analyses on LPS use in NC-FET suggested that, compared to AC-FET, NC-FET with LPS decreased preterm birth risk, while NC-FET without LPS did not (OR 0.75, 95% CI 0.70–0.81). LPS use did not modify the other outcomes. Heterogeneity varied from low to high, while quality of the evidence was very low to moderate. WIDER IMPLICATIONS This study confirms that NC-FET decreases the risk of adverse obstetric and neonatal outcomes compared with AC-FET. We estimate that for each adverse outcome, use of NC-FET may prevent 4 to 22 cases per 1000 women. Consequently, NC-FET should be the preferred treatment in women with ovulatory cycles undergoing FET. Based on very low quality of evidence, the risk of preterm birth be decreased when LPS is used in NC-FET compared to AC-FET. However, because of many uncertainties—the major being the debate about efficacy of the use of LPS—future research is needed on efficacy and safety of LPS and no recommendation can be made about the use of LPS.

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Section: Discussionmentioning

confidence: 99%

Obstetric and neonatal outcomes after natural versus artificial cycle frozen embryo transfer and the role of luteal phase support: a systematic review and meta-analysis

Zaat,

Kostova,

Korsen

et al. 2023

Human Reproduction Update

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“…11 In the Netherlands, practice variation exists in the triggers for administration of corticosteroids. 12 The early strategy comprises administration of corticosteroids when the UA PI exceeds the 95th centile and the late strategy when an A/REDF in the UA is observed. Comparative evidence of both approaches is lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Delivery based on imminent fetal hypoxia is unpredictable and for that reason clinicians use precursor monitoring variables that inherently have a lead‐time 11 . In the Netherlands, practice variation exists in the triggers for administration of corticosteroids 12 . The early strategy comprises administration of corticosteroids when the UA PI exceeds the 95th centile and the late strategy when an A/REDF in the UA is observed.…”

Section: Introductionmentioning

confidence: 99%

Practice variation in timing of antenatal corticosteroid administration in early‐onset fetal growth restriction: A secondary analysis of the Dutch STRIDER study

Prins,

van de Meent,

Kooiman

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionIn early‐onset fetal growth restriction the fetus fails to thrive in utero due to unmet fetal metabolic demands. This condition is linked to perinatal mortality and severe neonatal morbidity. Maternal administration of corticosteroids in high‐risk pregnancies for preterm birth at a gestational age between 24 and 34 weeks has been shown to reduce perinatal mortality and morbidity. Practice variation exists in the timing of the administration of corticosteroids based on umbilical artery monitoring findings in early‐onset fetal growth restriction. The aim of this study was to examine differences in neonatal outcomes when comparing different corticosteroid timing strategies.Material and methodsThis was a post‐hoc analysis of the Dutch STRIDER trial. We examined neonatal outcomes when comparing institutional strategies of early (umbilical artery pulsatility index >95th centile) and late (umbilical artery shows absent or reversed end‐diastolic flow) administration of corticosteroids. The primary outcomes were neonatal mortality and a composite of neonatal mortality and neonatal morbidity, defined as bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis or retinopathy of prematurity. We also analyzed predictors for adverse neonatal outcomes, including gestational age at delivery, birthweight, maternal hypertensive disorders, and time interval between corticosteroids and birth.ResultsA total of 120 patients matched our inclusion criteria. In 69 (57.5%) the early strategy was applied and in 51 (42.5%) patients the late strategy. Median gestational age at delivery was 28 4/7 (± 3, 3/7) weeks. Median birthweight was 708 (± 304) g. Composite primary outcome was found in 57 (47.5%) neonates. No significant differences were observed in the primary outcome between the two strategies (neonatal mortality adjusted odds ratio [OR] 1.22, 95% CI 0.44–3.38; composite primary outcome adjusted OR 1.05, 95% CI 0.42–2.64). Only gestational age at delivery was a significant predictor for improved neonatal outcome (adjusted OR 0.91, 95% CI 0.86–0.96).ConclusionsNo significant differences in neonatal outcomes were observed when comparing early and late strategy of antenatal corticosteroid administration on neonatal outcomes in pregnancies complicated by early‐onset fetal growth restriction. We found no apparent risk contribution of interval between corticosteroid administration and delivery in multivariate analysis. Gestational age at delivery was found to be an important predictor of neonatal outcome.

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High second‐trimester uterine artery impedance correlates to maternal vascular malperfusion and related‐complications

Carbillon

Benbara

Fermaut

2022

Acta Obstet Gynecol Scand

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Practice variation in diagnosis, monitoring and management of fetal growth restriction in the Netherlands

Cited by 4 publications

References 25 publications

Obstetric and neonatal outcomes after natural versus artificial cycle frozen embryo transfer and the role of luteal phase support: a systematic review and meta-analysis

Obstetric and neonatal outcomes after natural versus artificial cycle frozen embryo transfer and the role of luteal phase support: a systematic review and meta-analysis

Practice variation in timing of antenatal corticosteroid administration in early‐onset fetal growth restriction: A secondary analysis of the Dutch STRIDER study

High second‐trimester uterine artery impedance correlates to maternal vascular malperfusion and related‐complications

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