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Detection of Growth‐Restricted Fetuses in Preeclampsia: A Case‐Control Study

CHAUHAN, SUNEET P. MD; SCARDO, JAMES A. MD; MAGANN, EVERETT F. MD; DEVOE, LAWRENCE D. MD; HENDRIX, NANCY W. MD; MARTIN, JAMES N. Jr MD

Original Research

Objective: To determine the diagnostic accuracy of detecting growth-restricted fetuses in women with and without preeclampsia.

Methods: Over 2 years, parturients with reliable gestational ages, preeclampsia, and sonographic estimates of birth weights were matched (1:1) for gestational age with women without preeclampsia. Paired and unpaired t tests were used; P < .05 was significant. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results: Two hundred eighty-seven preeclamptic women were identified and matched. In each group, mean (± standard deviation [SD]) gestational age was 34.9 ± 4.2 weeks, and 166 (57.8%) infants were born preterm. Fetal growth restriction (FGR) was significantly more common among women with preeclampsia (14.9%) than among controls (5.6%; OR 2.98, 95% CI 1.64, 5.44). The percentage of sonographic estimates within 10% of actual birth weight (57.5% versus 53.6%) was similar in the two groups (OR 1.16; 95% CI 0.84,1.62). Compared with normal growth, the mean (± SD) standardized absolute error was significantly higher among those with FGR regardless of group (preeclampsia 109 ± 100 versus 158 ± 152 g/kg; P = .009; control 117 ± 103 versus 233 ± 206 g/kg; P < .001). Fetal growth restriction was detected more commonly among preeclamptic women than among controls (11.6% versus 0%; OR 4.74 95% CI 0.25, 90.31). The sensitivity and positive predictive value of FGR detection were 10% and 50%, respectively, among women with preeclampsia and 0% each among controls.

Conclusion: Although FGR was detected more frequently in fetuses of women with preeclampsia than in those of controls, the ability to predict it with sonography remained poor.

Among preeclamptic women (those with a sustained elevation of blood pressure [BP] of 140 mmHg systolic or 90 mmHg diastolic after 20 weeks' gestation, proteinuria, and edema1), detection of growth-restricted fetuses (weight less than 10th percentile for gestational age) is important because, with growth disturbances, mild diseases can become severe, fetal growth restriction (FGR) is associated with increased risk of poor perinatal outcome2 and neurodevelopmental delay,3 and conservative management of severe preeclampsia at 28 to 32 weeks' gestation depends on clinicians' ability to diagnose FGR. Fetal growth restriction can be a contraindication for expectant management of severe preeclampsia, especially very preterm disease. 4–6

Despite the importance of antenatal diagnosis of FGR among women with hypertensive disease, there is a paucity of reports on the diagnostic accuracy of identifying a growth-restricted fetus. The purpose of this case control study was to determine the accuracy of sonographic estimates of fetal weight to identify fetuses that will be born with weights below the 10th percentile to women with and without hypertensive disease of pregnancy.

Antenatal detection of growth-restricted fetuses in preeclamptic women is poor.

Division of Maternal-Fetal Medicine, Spartanburg Regional Healthcare System, Spartanburg, South Carolina; the Department of Obstetrics and Gynecology, University of Mississippi, Jackson, Mississippi; and the Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, Georgia.

Address reprint requests to: Suneet P. Chauhan, MD, Division of Maternal-Fetal Medicine, Spartanburg Regional Health Care System, 853 North Church Street, Suite 403, Spartanburg, SC 29303. E-mail: mfmchauhan@aol.com

Supported in part by Vicksburg Hospital Medical Foundation.

Received June 22, 1998. Received in revised form October 8, 1998. Accepted October 29, 1998.

© 1999 The American College of Obstetricians and Gynecologists