Perinatal impacts of fetal growth velocity on small-for-gestational-age fetuses: A retrospective cohort study in a tertiary center.

Abstract

Introduction: The perinatal risk of reduced growth velocity among small for gestational age (SGA) has been poorly studied. Therefore, we assessed the impact of abdominal fetal growth velocity on perinatal morbidity and mortality among SGA fetuses with positive umbilical artery end-diastolic flow.

Material and methods: This retrospective, single-center cohort study was conducted between January 1, 2018, and May 31, 2022, at a tertiary center. We included women with a singleton pregnancy, at least two ultrasounds with an estimated fetal weight in the <10th percentile at least 2 weeks apart between gestational weeks 24 and 36, and a positive umbilical artery end-diastolic flow. Abdominal circumference growth velocity (ACGV) was calculated. For each ACGV, a z-score was calculated using INTERGROWTH-21 standards. Reduced growth velocity (ACGV z score < -2) and normal (ACGV z score ≥ -2) groups were compared based on a composite perinatal criterion defined as one of the following: stillbirth, 5-min Apgar score <7, arterial pH at birth <7.10, neonatal intensive care unit admission, or infant death before discharge.

Results: Among the 216 women included, 14.4% (31/216) had a fetus with reduced abdominal circumference growth velocity group and 85.6% (185/216) had a fetus with normal ACGV. Adverse neonatal outcomes occurred significantly more often in the reduced growth velocity group (58% in the reduced ACGV group vs 33% in the normal ACGV; p = 0.007). Nulliparous women, hypertensive disorders, and cerebroplacental redistribution at baseline and final Doppler examinations were significantly more frequent in the reduced ACGV group. After adjustment for confounding factors, ACGV z score < -2 was not significantly associated with an increased risk of perinatal adverse outcome (adjusted odds ratio [ORa] = 1.99), (95% confidence interval [CI]: [0.8-4.91]). However, hypertensive disorders (ORa = 4.48, 95% CI: [2-10.02]), cerebroplacental redistribution on the final Doppler examination (ORa = 3.12, 95% CI: [1.07-9.05]), and gestational diabetes (ORa = 3.72, 95% CI: [1.62-8.54]) remained statistically associated with increased perinatal morbidity risk.

Conclusions: Among SGA fetuses, reduced abdominal circumference growth velocity was not associated with an increased adverse perinatal outcome risk. Further studies are needed to determine the impact of growth velocity on the issues of SGA fetuses.