Risk factors and pregnancy outcomes of term fetal growth restriction Abstract

Kit Wu YIP, Choi Wah KONG, William Wing Kee TO
Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
Objective: To evaluate the maternal risk factors associated with term fetal growth restriction (FGR) and immediate perinatal outcomes in these pregnancies.
Methods: This was a retrospective cohort study conducted at a regional obstetric unit in Hong Kong over a 6-year period. All singleton livebirths delivered at term (≥37 weeks of gestation) were analysed. Those with major congenital abnormalities were excluded. Maternal epidemiological and anthropometric characteristics, presence of antenatal complications (gestational diabetes and medical disorders), and pregnancy outcomes (need for labour induction, mode of delivery, Apgar scores, occurrence of shoulder dystocia, and birth trauma) were compared between those with FGR (defined as birthweight ≤10th percentile for gestation) and those with birthweight appropriate for gestational age. Logistic regression analysis was conducted to identify risk factors associated with FGR.
Results: From 2012 to 2017, 24 010 singleton term livebirths were stratified into FGR (n=2425, 10%), appropriate for gestational age (n=19 162, 80%), and large for gestational age. Those classified as FGR were compared with those appropriate for gestational age pregnancies. A logistic regression model confirmed that the key risk factors for FGR included maternal underweight (adjusted odds ratio [OR]=1.88), hypertensive disorders of pregnancy (adjusted OR=1.78), smoking (adjusted OR=2.02), and antenatal anaemia (adjusted OR=1.20), whereas multiparity, gestational diabetes, and hepatitis B antigen carrier status were apparently protective. Pregnancies with FGR were more likely to undergo induction of labour, but were less likely to have shoulder dystocia, Caesarean section, or postpartum haemorrhage.
Conclusion: Despite the inherent risks associated with FGR at term, the immediate perinatal outcomes of these pregnancies appeared to be comparable to those appropriate for gestational age. 

Hong Kong J Gynaecol Obstet Midwifery 2019; 19(1):18–24
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