Skip Navigation LinksHome > August 2013 - Volume 122 - Issue 2, PART 1 > The Role of Growth Trajectories in Classifying Fetal Growth...
Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31829ca9a7
Original Research

The Role of Growth Trajectories in Classifying Fetal Growth Restriction

Barker, Edward D. PhD; McAuliffe, Fionnuala M. MD; Alderdice, Fiona PhD; Unterscheider, Julia MD; Daly, Sean MD; Geary, Michael P. MD; Kennelly, Mairead M. MD; O'Donoghue, Keelin PhD; Hunter, Alyson MD; Morrison, John J. MD; Burke, Gerard; Dicker, Patrick PhD; Tully, Elizabeth C. PhD; Malone, Fergal D. MD

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Abstract

OBJECTIVE: To examine the validity of a growth trajectory method to discriminate between pathologically and constitutionally undergrown fetuses using repeated measures of estimated fetal weight.

METHODS: In a prospective, observational, multicenter study in Ireland, 1,116 women with a growth-restricted fetus diagnosed participated with the objective of evaluating ultrasound findings as predictors of pediatric morbidity and mortality. Fetal growth trajectories were based on estimated fetal weight.

RESULTS: Between 22 weeks of gestation and term, two fetal growth trajectories were identified: normal (96.7%) and pathologic (3.3%). Compared with the normal trajectory, the pathologic trajectory was associated with an increased risk for preeclampsia (odds ratio [OR] 8.1, 95% confidence interval [CI] 2.6–23.4), increased umbilical artery resistance at 30 weeks of gestation (OR 12.6, 95% CI 4.6–34.1) or 34 weeks of gestation (OR 28.0, 95% CI 8.9–87.7), reduced middle cerebral artery resistance at 30 weeks of gestation (OR 0.33, 95% CI 0.12–0.96) or 34 weeks of gestation (OR 0.14, 95% CI 0.03–0.74), lower gestational age at delivery (mean 32.02 weeks of gestation compared with 38.02 weeks of gestation; P<.001), and higher perinatal complications (OR 21.5, 95% CI 10.5–44.2). In addition, 89.2% of newborns with pathologic fetal growth were admitted to neonatal intensive care units compared with 25.9% of those with normal growth.

CONCLUSIONS: Fetal growth trajectory analysis reliably differentiated fetuses with a pathologic growth pattern among a group of women with growth-restricted fetuses. With further development, this approach could provide clarity to how we define, identify, and ultimately manage pathologic fetal growth.

LEVEL OF EVIDENCE: II

© 2013 by The American College of Obstetricians and Gynecologists.

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