Nakahra Angela, Long Miranda, Elmayan Ardem, Biggio Joseph R, Williams Frank B
Department of Obstetrics and Gynecology, Ochsner Health, New Orleans, Louisiana.
Department of Research Information Analytics, Ochsner Health, New Orleans, Louisiana.
Am J Perinatol. 2025 Mar;42(4):526-532. doi: 10.1055/a-2435-0468. Epub 2024 Oct 7.
Fetal growth restriction (FGR) increases the risk for perinatal morbidity and mortality. The Society for Maternal-Fetal Medicine expanded the definition of FGR to independently include abdominal circumference (AC) < 10th percentile for gestational age (GA), regardless of estimated fetal weight (EFW). While studies have shown increased detection of small for GA neonates with expanded definition, no studies have evaluated the likelihood of abnormal umbilical artery Dopplers (UAD) detection with expanded definition. The objective of this study was to compare the likelihood of identifying UAD abnormalities in fetuses with normal EFW and restricted AC versus those by EFW alone.
Single-institution retrospective cohort study of fetal growth ultrasounds meeting criteria for FGR either by EFW < 10th percentile or AC < 10th percentile with normal EFW. Those with FGR by AC alone were compared with those with FGR by EFW. Primary outcome was prevalence of UAD abnormalities, including elevated systolic/diastolic ratio, and absent and/or reversed end diastolic velocity. Receiver operator characteristic curves were generated to compare predictive value of UAD abnormalities by FGR definition.
A total of 619 scans met criteria for FGR between November 2020 and June 2021, with 441 (71%) meeting definition by EFW and 178 (29%) by AC criteria alone. Baseline characteristics were similar between groups. FGR by AC alone was identified earlier (30.4 ± 3.3 vs. 35.4 ± 3.0 weeks' gestation, < 0.001) with higher proportion identified before 32 weeks (70 vs. 11%, < 0.001). Proportion of abnormal UAD were similar between groups (15 vs. 15%, adjusted odds ratio: 1.12, 95% confidence interval: 0.61-2.23). Use of EFW alone would have failed to identify 29% of abnormal UAD. A combined definition of FGR had the highest detection of abnormal UAD (area under curve: 0.78 vs. AC alone 0.73 vs. EFW alone 0.69).
A definition of FGR that considers both EFW and AC improves detection of abnormal UAD.
· Fetuses with restricted AC are equally likely to exhibit abnormal UAD indices compared with those that meet criteria by EFW.. · Earlier GA of FGR detection and improved detection of abnormal UAD with expanded growth definition.. · Expanded definition of FGR significantly improves detection of abnormal UAD as compared with those diagnosed with EFW criteria alone.. · Expanded growth restriction definition improves Doppler identification..
胎儿生长受限（FGR）会增加围产期发病和死亡风险。母胎医学协会扩大了FGR的定义，单独纳入腹围（AC）低于胎龄（GA）第10百分位数，而不考虑估计胎儿体重（EFW）。虽然研究表明扩大定义后小于胎龄新生儿的检出率有所增加，但尚无研究评估扩大定义后脐动脉多普勒（UAD）异常检测的可能性。本研究的目的是比较单纯估计胎儿体重正常但腹围受限的胎儿与单纯根据估计胎儿体重诊断的胎儿中识别UAD异常的可能性。
对符合FGR标准的胎儿生长超声进行单机构回顾性队列研究，FGR标准为EFW低于第10百分位数或EFW正常但AC低于第10百分位数。将单纯因AC诊断为FGR的胎儿与因EFW诊断为FGR的胎儿进行比较。主要结局是UAD异常的发生率，包括收缩压/舒张压比值升高、舒张末期血流速度消失和/或反向。生成受试者工作特征曲线以比较FGR定义对UAD异常的预测价值。
2020年11月至2021年6月期间，共有619次扫描符合FGR标准，其中441次（71%）符合EFW定义，178次（29%）仅符合AC标准。两组间基线特征相似。单纯因AC诊断为FGR的胎儿诊断时间更早（妊娠30.4±3.3周 vs. 35.4±3.0周，P<0.001），32周前诊断的比例更高（70% vs. 11%，P<0.001）。两组间UAD异常比例相似（15% vs. 15%，调整比值比：1.12，95%置信区间：0.61-2.23）。仅使用EFW会漏诊29%的UAD异常。FGR的联合定义对UAD异常的检测率最高（曲线下面积：0.78 vs. 单纯AC为0.73 vs. 单纯EFW为0.69）。
同时考虑EFW和AC的FGR定义可提高UAD异常的检测率。
· 与符合EFW标准的胎儿相比，AC受限的胎儿出现UAD异常指标的可能性相同。· FGR检测的孕周更早，扩大生长定义可提高UAD异常的检测率。· 与仅根据EFW标准诊断的胎儿相比，FGR的扩大定义显著提高了UAD异常的检测率。· 扩大生长受限定义可改善多普勒识别。
