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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

doi: 10.1097/AOG.0b013e31829ca9a7
Original Research

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.


Fetal growth trajectory analysis may reliably differentiate fetuses with a pathologic growth pattern among a group of growth-restricted fetuses.

Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom; and the UCD Obstetrics and Gynecology, School of Medicine and Medical Science, National Maternity Hospital, University College Dublin, Royal College of Surgeons in Ireland, Coombe Women and Infants University Hospital, and Rotunda Hospital, Dublin, University College Cork, Cork University Maternity Hospital, Cork, Royal Jubilee Maternity Hospital, Belfast, National University of Ireland, Galway, and Graduate Entry Medical School, University of Limerick, Limerick; University College Dublin Center for Human Reproduction, Coombe Women and Infants University Hospital, Dublin; Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin; and School of Nursing and Midwifery, Queens University, Belfast, Ireland.

Corresponding author: Dr. Edward D. Barker, Department of Psychology, King's College London, Institute of Psychiatry, PO Box 077, De Crespigny Park, London, SE5 8AF, UK; e-mail:

Funded by the Health Research Board Ireland.

The authors thank Fiona Manning, original Perinatal Ireland research manager, and the team of Perinatal Ireland research sonographers Fiona Cody, Hilda O’Keefe, Emma Doolin, Cecelia Mulcahy, Azy Khalid, Phyl Gargan, Annette Burke, Edel Varden, Wendy Ooi, and Amanda Ali for their work on the trial.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.