Comparative Analysis of Risk Indicators, Pregnancy Outcomes and Neonatal Prognosis between Early-Onset and Late-Onset Fetal Growth Restriction
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v6i1.3704
Abstract
This study compares the risk indicators of early-onset and late-onset of fetal growth restriction (FGR) and their impact on pregnancy outcomes. Clinical data of 195 pregnant women (early-onset group, 47 cases; late-onset group, 148 cases) who had singleton pregnancies and experienced FGR were retrospectively analyzed. The comparative analysis assessed the risk indicators, pregnancy outcomes, and neonatal outcomes between the two groups. The overall incidence of hypertensive disorders of pregnancy (HDP) in cases of FGR was 22.05%. The incidence rate of HDP in the early-onset group was relatively higher (p<0.001). In the early-onset group, incidence rates of umbilical blood flow abnormalities, premature births, and cesarean section deliveries were comparatively higher (all p<0.05). Gestational age at delivery in the early-onset group was significantly lower (p<0.001). Moreover, the birth weight of newborns in the early-onset group was significantly lower (p<0.001). The early-onset group exhibited relatively high incidence rates of neonatal jaundice, neonatal infection, and intracranial hemorrhage (all p<0.05). Duration of hospitalization was also significantly longer than in the early-onset group (p<0.001). HDP is a high-risk factor for early-onset FGR. Moreover, early-onset of FGR is associated with a relatively high propensity for adverse pregnancy outcomes and poorer neonatal prognosis.
Keywords
early-onset fetus, late-onset fetus, fetal growth restriction, pregnancy outcome
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[24]Xiao J, Zhu FF. Analysis the Correlative Factors of 140 FGR With Different Gestation Ages. J Pract Obstet Gynaecol. 2011;27:539-541.
[25]Rubin JM, Fowlkes JB, Pinter SZ, et al. Umbilical Vein Pulse Wave Spectral Analysis: A Possible Method for Placental Assessment Through Evaluation of Maternal and Fetal Flow Components. J Ultrasound Med. 2022;41(10):2445-2457.
[26]Moon KC, Park CW, Park JS, et al. Fetal Growth Restriction and Subsequent Low Grade Fetal Inflammatory Response Are Associated with Early-Onset Neonatal Sepsis in the Context of Early Preterm Sterile Intrauterine Environment. J Clin Med. 2021;10(9):2018.
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[28]Mitra S, Rennie J. Neonatal jaundice: aetiology, diagnosis and treatment. Br J Hosp Med (Lond). 2017;78(12):699-704.
[29]Tan AP, Svrckova P, Cowan F, et al. Intracranial hemorrhage in neonates: A review of etiologies, patterns and predicted clinical outcomes. Eur J Paediatr Neurol. 2018;22(4):690-717.
[30]Daskalakis G, Pergialiotis V, Domellöf M, et al. European guidelines on perinatal care: corticosteroids for women at risk of preterm birth. J Matern Fetal Neonatal Med. 2023;36(1):2160628.
[2]Wu J, Lu AD, Zhang LP, et al. Study of clinical outcome and prognosis in pediatric core binding factor-acute myeloid leukemia. Chin J Hematol. 2019;40(1):52-57.
[3]Damhuis SE, Ganzevoort W, Gordijn SJ. Abnormal Fetal Growth: Small for Gestational Age, Fetal Growth Restriction, Large for Gestational Age: Definitions and Epidemiology. Obstet Gynecol Clin North Am. 2021;48(2):267-279.
[4]American College of Obstetricians and Gynecologists' Committee on Practice Bulletins — Obstetrics and the Society forMaternal-FetalMedicin. ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol. 2019;133(2):e97-e109.
[5]Pels A, Beune IM, van Wassenaer-Leemhuis AG, et al. Early-onset fetal growth restriction: A systematic review on mortality and morbidity. Acta Obstet Gynecol Scand. 2020;99(2):153-166.
[6]Francis JH, Permezel M, Davey MA. Perinatal mortality by birthweight centile. Aust N Z J Obstet Gynaecol. 2014;54(4):354-359.
[7]Freedman AA, Silver RM, Gibbins KJ, et al. The association of stillbirth with placental abnormalities in growth-restricted and normally grown fetuses. Paediatr Perinat Epidemiol. 2019;33(4):274-383.
[8]Gerosa C, Faa G, Fanni D, et al. Fetal programming of atherosclerosis: may the barker hypothesis explain the susceptibility of a subset of patients to develop stroke or cardiac infarct? Eur Rev Med Pharmacol Sci. 2021;25(21):6633-6641.
[9]Meher S, Hernandez-Andrade E, Basheer SN, et al. Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review. Ultrasound Obstet Gynecol. 2015;46(4):398-404.
[10]GRIT Study Group. A randomised trial of timed delivery for the compromised preterm fetus: short term outcomes and Bayesian interpretation. BJOG. 2003;110(1):27-32.
[11]Thornton JG, Hornbuckle J, Vail A, et al. Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial. Lancet. 2004;364(9433):513-520.
[12]Walker DM, Marlow N, Upstone L, et al. The Growth Restriction Intervention Trial: long-term outcomes in a randomized trial of timing of delivery in fetal growth restriction. Am J Obstet Gynecol. 2011;204(1):34.e1-34.e9.
[13]Lees CC, Marlow N, van Wassenaer-Leemhuis A, et al. 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet. 2015;385(9983):2162-2172.
[14]Lees CC, Stampalija T, Baschat A, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol. 2020;56(2):298-312.
[15]Gordijn SJ, Beune IM, Thilaganathan B, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48(3):333-339.
[16]Xiao WL, Pan SL, Cai W, et al. Comparison of the etiology and pregnancy outcome of fetal growth restriction in early-onset and late-onset singletons. Shandong Med J. 2020;60(18):75-77.
[17]Borrell A, Grande M, Meler E, et al. Genomic Microarray in Fetuses with Early Growth Restriction: A Multicenter Study. Fetal Diagn Ther. 2017;42(3):174-180.
[18]Malhotra A, Allison BJ, Castillo-Melendez M, et al. Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact. Front Endocrinol (Lausanne). 2019;10:55.
[19]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.
[20]Muniz CS, Dias BF, Motoyama PVP, et al. Doppler abnormalities and perinatal outcomes in pregnant women with early-onset fetal growth restriction. J Matern Fetal Neonatal Med. 2022;35(257276-7279.
[21]Mureșan D, Rotar IC, Stamatian F. The usefulness of fetal Doppler evaluation in early versus late onset intrauterine growth restriction. Review of the literature. Med Ultrason. 2016;18(1):103-109.
[22]Ashraf UM, Hall DL, Rawls AZ, et al. Epigenetic processes during preeclampsia and effects on fetal development and chronic health. Clin Sci (Lond). 2021;135(19):2307-2327.
[23]Burton GJ, Jauniaux E. Pathophysiology of placental-derived fetal growth restriction. Am J Obstet Gynecol. 2018;218(2S):S745-S761.
[24]Xiao J, Zhu FF. Analysis the Correlative Factors of 140 FGR With Different Gestation Ages. J Pract Obstet Gynaecol. 2011;27:539-541.
[25]Rubin JM, Fowlkes JB, Pinter SZ, et al. Umbilical Vein Pulse Wave Spectral Analysis: A Possible Method for Placental Assessment Through Evaluation of Maternal and Fetal Flow Components. J Ultrasound Med. 2022;41(10):2445-2457.
[26]Moon KC, Park CW, Park JS, et al. Fetal Growth Restriction and Subsequent Low Grade Fetal Inflammatory Response Are Associated with Early-Onset Neonatal Sepsis in the Context of Early Preterm Sterile Intrauterine Environment. J Clin Med. 2021;10(9):2018.
[27]Yadav P, Yadav SK. Progress in Diagnosis and Treatment of Neonatal Sepsis: A Review Article. J Nepal Med Assoc. 2022;60(247):318-324.
[28]Mitra S, Rennie J. Neonatal jaundice: aetiology, diagnosis and treatment. Br J Hosp Med (Lond). 2017;78(12):699-704.
[29]Tan AP, Svrckova P, Cowan F, et al. Intracranial hemorrhage in neonates: A review of etiologies, patterns and predicted clinical outcomes. Eur J Paediatr Neurol. 2018;22(4):690-717.
[30]Daskalakis G, Pergialiotis V, Domellöf M, et al. European guidelines on perinatal care: corticosteroids for women at risk of preterm birth. J Matern Fetal Neonatal Med. 2023;36(1):2160628.
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