Temming LA, et al. - In this study, researchers evaluated the risk of adverse perinatal outcomes among women with isolated fetal growth restriction from 17 to 22 weeks of gestation. Albeit fetal growth restriction in the early second trimester occurred in under 3% of the cohort and most of those with isolated growth restriction did not have adverse outcomes, it is a strong risk factor for small for gestational age (SGA), stillbirth, neonatal death, and indicated preterm birth.

Methods

• For this research, they designed a retrospective cohort study.
• This was the study of all singleton, nonanomalous pregnancies going through ultrasonography to evaluate fetal anatomy between 17 and 22 weeks of gestation.
• This study was conducted at a single center from 2010 to 2014.
• After excluding patients with fetal structural malformations, chromosomal abnormalities, or identified infectious etiologies, they compared perinatal outcomes between pregnancies with and without fetal growth restriction, defined as estimated fetal weight less than the 10th percentile for gestational age.
• Their primary outcome was small for gestational age (SGA) at birth, defined as birth weight not more than the 10th percentile.
• Secondary outcomes included preterm delivery at under 37 and less than 28 weeks of gestation, preeclampsia, abruption, stillbirth, neonatal death, neonatal intensive care unit admission, intraventricular hemorrhage, need for respiratory support, and necrotizing enterocolitis.

Results

• Total 12,783 patients were eligible for this study.
• Among these, 355 (2.8%) had early second-trimester fetal growth restriction.
• African American race and tobacco use were the risk factors for growth restriction.
• Early second-trimester growth restriction was related to a more than fivefold increase in risk of SGA at birth (36.9% compared with 9.1%, adjusted odds ratio [OR] 5.5, 95% CI 4.3-7.0), stillbirth (2.5% compared with 0.4%, OR 6.2, 95% CI 2.7-12.8), and neonatal death (1.4% compared with 0.3%, OR 5.2, 95% CI 1.6-13.5).
• Rates of indicated preterm birth at under 37 weeks of gestation (7.3% compared with 3.3%, OR 2.3, 95% CI 1.5-3.5) and under 28 weeks of gestation (2.5% compared with 0.2%, OR 10.8, 95% CI 4.5-23.4), neonatal need for respiratory support (16.9% compared with 7.8%, adjusted OR 1.6, 95% CI 1.1-2.2), and necrotizing enterocolitis (1.4% compared with 0.2%, OR 7.7, 95% CI 2.3-20.9) were also significantly higher for those with growth restriction.
• Rates of preeclampsia, abruption, and other neonatal outcomes were not significantly different.