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Effect of antenatal detection of small-for-gestational-age newborns in a risk stratified retrospective cohort


Autoři: Anna Kajdy aff001;  Jan Modzelewski aff001;  Monika Jakubiak aff001;  Artur Pokropek aff002;  Michał Rabijewski aff001
Působiště autorů: Centre of Postgraduate Medical Education, Department of Reproductive Health, Warsaw, Poland aff001;  Institute of Philosophy and Sociology Polish Academy of Sciences, Warsaw, Poland aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224553

Souhrn

Objective

Small-for-gestational-age (SGA) are neonates born with birth weight below the 10th centile for a given week of pregnancy. It is a risk factor of perinatal and neonatal morbidity and mortality. There is an ongoing debate whether prenatal detection of SGA neonates is good predictor of perinatal outcome especially in low risk populations. Our primary aim was to compare the odds ratios for unfavorable outcome in a risk stratified cohort of SGA neonates in regard to prenatal detection status.

Methods

This is a retrospective cohort study analysing the effect of prenatal detection on perinatal outcome. This cohort has been divided into a predefined low-risk and high-risk population. Electronic records of 39,032 singleton deliveries from 2010 through 2016 were analysed. SGA was defined as newborn weight below the 10th percentile on the Fenton growth chart. Detected SGA (dSGA) neonates were those that were admitted for delivery with a prenatal ultrasound diagnosis of abnormal growth. Undetected SGA (uSGA) were neonates that were found to be below the 10th percentile after birth. Perinatal and neonatal outcome was compared.

Results

The detection rate in high-risk pregnancies was almost 45.7% versus low risk where it amounted to 18.9%. In both the high-risk and low-risk populations there was a significantly higher risk of composite mortality for undetected SGA compared to approporiate-for-gestational-age (AGA) (OR 7.95 CI 4.76–13.29; OR 14.4 CI 4.99–41.45 respectively). The odds for the composite neonatal outcome were significantly higher for dSGA and uSGA than for AGA in all the studied populations except for the uSGA in high risk population (OR 1.57 CI 0.97–3.53). Importantly, there was not a single case of intrauterine fetal death among detected SGA, in the low risk group.

Conclusions

Prenatal detection of SGA status is related to perinatal outcomes, especially mortality. Therefore, assessment of SGA status even in low-risk pregnancies could help predict potential perinatal and neonatal complications.

Klíčová slova:

Fetal death – Hypertensive disorders in pregnancy – Management of high-risk pregnancies – Neonatal sepsis – Neonates – Obesity


Zdroje

1. Figueras F, Gratacós E. Update on the Diagnosis and Classification of Fetal Growth Restriction and Proposal of a Stage-Based Management Protocol. Fetal Diagn Ther. 2014;36(2):86–98. doi: 10.1159/000357592 24457811

2. American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol. 2013;121(5):1122–1133. doi: 10.1097/01.AOG.0000429658.85846.f9 23635765

3. Larsen T, Larsen JF, Petersen S, Greisen G. Detection of small-for-gestational-age fetuses by ultrasound screening in a high risk population: a randomized controlled study. Br J Obstet Gynaecol. 1992;99(6):469–474. doi: 10.1111/j.1471-0528.1992.tb13783.x 1637761

4. The Royal College of Obstetricians and Gynaecologists. The Investigation and Management of the Small–for–Gestational–Age Fetus. Green-Top Guidel. 2013;31. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_31.pdf. Accessed May 7, 2018.

5. Institute of Obstetricians and Gynaecologists Royal of College of Phisicans of Ireland. Fetal growth restriction—recognition, diagnosis & managment. Clin Pract Guidel. 2017;28. https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/fetal-growth-restriction.pdf. Accessed May 7, 2018.

6. Lausman A, Kingdom J, Gagnon R, Basso M, Bos H, Crane J, et al. Intrauterine Growth Restriction: Screening, Diagnosis, and Management. J Obstet Gynaecol Can. 2013;35(8):741–748. doi: 10.1016/S1701-2163(15)30865-3 24007710

7. Larkin J, Chauhan S, Simhan H. Small for Gestational Age: The Differential Mortality When Detected versus Undetected Antenatally. Am J Perinatol. 2016;34(04):409–414. doi: 10.1055/s-0036-1592132 27627793

8. Policiano C, Fonseca A, Mendes JM, Clode N, Graça LM. Small-for-gestational-age babies of low-risk term pregnancies: does antenatal detection matter? J Matern Fetal Neonatal Med. April 2017:1–5. doi: 10.1080/14767058.2017.1317741 28391748

9. Mendez-Figueroa H, Truong VTT, Pedroza C, Khan AM, Chauhan SP. Small-for-gestational-age infants among uncomplicated pregnancies at term: a secondary analysis of 9 Maternal-Fetal Medicine Units Network studies. Am J Obstet Gynecol. 2016;215(5):628.e1–628.e7. doi: 10.1016/j.ajog.2016.06.043 27372269

10. Figueras F, Gardosi J. Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management. Am J Obstet Gynecol. 2011;204(4):288–300. doi: 10.1016/j.ajog.2010.08.055 21215383

11. Hepburn M, Rosenberg K. An audit of the detection and management of small-for-gestational age babies. Br J Obstet Gynaecol. 1986;93(3):212–216. doi: 10.1111/j.1471-0528.1986.tb07895.x 3964595

12. Backe B, Nakling J. Effectiveness of antenatal care: a population based study. Br J Obstet Gynaecol. 1993;100(8):727–732. doi: 10.1111/j.1471-0528.1993.tb14263.x 8399010

13. Sovio U, White IR, Dacey A, Pasupathy D, Smith GCS. Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. The Lancet. 2015;386(10008):2089–2097. doi: 10.1016/S0140-6736(15)00131-2 26360240

14. Fenton TR. A new growth chart for preterm babies: Babson and Benda’s chart updated with recent data and a new format. BMC Pediatr. 2003;3(1). doi: 10.1186/1471-2431-3-13 14678563

15. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59. doi: 10.1186/1471-2431-13-59 23601190

16. EUROCAT Central Registry. EUROCAT Guide 1.4: Instruction for the registration of congenital anomalies. http://www.eurocat-network.eu/content/Full%20Guide%201%204%20version%2020_Dec2017_clean.pdf. Accessed May 7, 2018.

17. Pray L, ed. An Update on Research Issues in the Assessment of Birth Settings: Workshop Summary. Washington: National Academies Press; 2013. http://www.ncbi.nlm.nih.gov/books/NBK201937/. Accessed May 7, 2018.

18. Figueras F, Gratacos E, Rial M, Gull I, Krofta L, Lubusky M, et al. Revealed versus concealed criteria for placental insufficiency in an unselected obstetric population in late pregnancy (RATIO37): randomised controlled trial study protocol. BMJ Open. 2017;7(6). doi: 10.1136/bmjopen-2016-014835 28619771

19. Butt K, Lim K, Lim K, Bly S, Butt K, Cargill Y, et al. Determination of Gestational Age by Ultrasound. J Obstet Gynaecol Can. 2014;36(2):171–181. doi: 10.1016/S1701-2163(15)30664-2 24518917

20. Cole SR, Chu H, Greenland S. Maximum Likelihood, Profile Likelihood, and Penalized Likelihood: A Primer. Am J Epidemiol. 2014;179(2):252–260. doi: 10.1093/aje/kwt245 24173548

21. Royston Patrick. Multiple imputation of missing values. Stata J 2004 4 Number 3 Pp 227–241.:15.

22. Little R. and Rubin D. (1987) Statistical Analysis with Missing Data. John Wiley and Sons Publishers, New York.

23. ILO (2012). International Standard Classification of Occupations. Geneva: International Labour Office. Retrieved from http://www.ilo.org/wcmsp5/groups/public/—dgreports/—dcomm/—publ/documents/publication/wcms_172572.pdf.

24. Winbo I, Serenius F, Dahlquist G, Källén B. Maternal risk factors for cause-specific stillbirth and neonatal death. Acta Obstet Gynecol Scand. 2001;80(3):235–244. doi: 10.1034/j.1600-0412.2001.080003235.x 11207489

25. Ego A, Zeitlin J, Batailler P, Cornec S, Fondeur A, Baran-Marszak M, et al. Stillbirth classification in population-based data and role of fetal growth restriction: the example of RECODE. BMC Pregnancy Childbirth. 2013;13(1):182.

26. Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013;346(jan24 3):f108–f108. doi: 10.1136/bmj.f108 23349424

27. Gardosi J, Giddings S, Clifford S, Wood L, Francis A. Association between reduced stillbirth rates in England and regional uptake of accreditation training in customised fetal growth assessment. BMJ Open. 2013;3(12):e003942. doi: 10.1136/bmjopen-2013-003942 24345900

28. Gaillard R, Jaddoe VWV. Assessment of Fetal Growth by Customized Growth Charts. Ann Nutr Metab. 2014;65(2–3):149–155. doi: 10.1159/000361055 25413653

29. Polish Society of Obstetrics and Gynecology. Recommendations of the Polish Society of Obstetrics and Gynecology for prenatal care in normal pregnancy. Ginekol Pol. 2005;76(7):517–527. 16363377

30. Madden JV, Flatley CJ, Kumar S. Term small-for-gestational-age infants from low-risk women are at significantly greater risk of adverse neonatal outcomes. Am J Obstet Gynecol. 2018;218(5):525.e1–525.e9. doi: 10.1016/j.ajog.2018.02.008 29462628

31. Narchi H, Skinner A, Williams B. Small for gestational age neonates–are we missing some by only using standard population growth standards and does it matter? J Matern Fetal Neonatal Med. 2010;23(1):48–54. doi: 10.3109/14767050903067352 19565425

32. Agarwal P, Rajadurai VS, Yap F, Yeo G, Chong YS, Kwek K, et al. Comparison of customized and cohort-based birthweight standards in identification of growth-restricted infants in GUSTO cohort study. J Matern Fetal Neonatal Med. October 2015:1–4. doi: 10.3109/14767058.2015.1092956 26366791

33. Borgonovi F. A life-cycle approach to the analysis of the relationship between social capital and health in Britain. Soc Sci Med 1982. 2010;71(11):1927–1934. doi: 10.1016/j.socscimed.2010.09.018 20943301


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