The role of growth trajectories in classifying fetal growth restriction.


OBJECTIVE To examine the validity of a growth trajectory method to discriminate between pathologically and constitutionally undergrown fetuses using repeated measures of estimated fetal weight. METHODS In a prospective, observational, multicenter study in Ireland, 1,116 women with a growth-restricted fetus diagnosed participated with the objective of evaluating ultrasound findings as predictors of pediatric morbidity and mortality. Fetal growth trajectories were based on estimated fetal weight. RESULTS Between 22 weeks of gestation and term, two fetal growth trajectories were identified: normal (96.7%) and pathologic (3.3%). Compared with the normal trajectory, the pathologic trajectory was associated with an increased risk for preeclampsia (odds ratio [OR] 8.1, 95% confidence interval [CI] 2.6-23.4), increased umbilical artery resistance at 30 weeks of gestation (OR 12.6, 95% CI 4.6-34.1) or 34 weeks of gestation (OR 28.0, 95% CI 8.9-87.7), reduced middle cerebral artery resistance at 30 weeks of gestation (OR 0.33, 95% CI 0.12-0.96) or 34 weeks of gestation (OR 0.14, 95% CI 0.03-0.74), lower gestational age at delivery (mean 32.02 weeks of gestation compared with 38.02 weeks of gestation; P<.001), and higher perinatal complications (OR 21.5, 95% CI 10.5-44.2). In addition, 89.2% of newborns with pathologic fetal growth were admitted to neonatal intensive care units compared with 25.9% of those with normal growth. CONCLUSIONS Fetal growth trajectory analysis reliably differentiated fetuses with a pathologic growth pattern among a group of women with growth-restricted fetuses. With further development, this approach could provide clarity to how we define, identify, and ultimately manage pathologic fetal growth. LEVEL OF EVIDENCE II.

DOI: 10.1097/AOG.0b013e31829ca9a7

Cite this paper

@article{Barker2013TheRO, title={The role of growth trajectories in classifying fetal growth restriction.}, author={Edward Dylan Barker and Fionnuala M Mcauliffe and Fiona A . Alderdice and Julia Unterscheider and Sean F Daly and Michael Patrick Geary and Mairead Mary Kennelly and Keelin OʼDonoghue and Alan Hunter and John Joseph Morrison and Gerard Burke and Patrick Dicker and Elizabeth Catherine Tully and Fergal Desmond Malone}, journal={Obstetrics and gynecology}, year={2013}, volume={122 2 Pt 1}, pages={248-54} }