Difference between maternal risk factors for fetal growth restriction and small for gestational age

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Abstract

Objective: This study aimed to compare the maternal gestational risks of insufficient fetal growth (IFG), including small for gestational age (SGA) and fetal growth restriction (FGR).

Materials and methods: This retrospective cohort study was conducted at Perinatal center of N.A. Semashko Republican Clinical Hospital between 2018 and 2023. The study included 611 women with IFG, including 435 with FGR and 176 with SGA. The discriminators of FGR and SGA were studied. Statistical analysis was performed using Statistica 12.0 and Microsoft Excel 2007, and CHAID analysis was conducted using the Classification Trees module.

Results: Potential causes of IFG were hypertensive disorders during pregnancy (41.74%), including preeclampsia (PE) (25.21%), severe (22.59%) or moderate (2.62%), gestational hypertension (GAH) (8.67%), chronic arterial hypertension (CAH) (7.86%), and gestational diabetes mellitus (GDM) (12.77%). The cause of IFG was unknown in 45.49% of women. FGR was more likely to be associated with PE of unknown cause (OR=1.94); SGA was associated with GDM (OR=8.76), GAH (OR=4.38), and CAH (OR=3.93). Prematurity is not obligatory for IFG (24.22%) but is typical for FGR (34.02%). Preterm delivery was associated with severe PE (OR=14.89) and CAH (OR=2.43). The rate of cesarean section for IFG was 55.16% and was associated with FGR (OR=2.95), PE or CAH in FGR, GAH (OR=12.00), and an unknown cause (OR=2.05) in SGA infants. The incidence of iatrogenic prematurity in IFG due to FGR was 86.48 %. Low birth weight (LBW) was more common in the FGR group (OR=6.38).

Conclusion: The FGR and SGA differ in terms of risk factors. The causes of IFG are associated with the risk of iatrogenic prematurity and LBW. Prevention of gestational complications of cardiometabolic origin (hypertensive disorders and GDM) is a measure for preventing IFG. The association of PE with FGR, but not with SGA, confirms the similarity of their pathogenesis and the impossibility of uniform prevention of both IFG variants.

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About the authors

Arsen A. Ziyadinov

N.A. Semashko Republican Clinical Hospital, Perinatal Center; S.I. Georgievsky Medical Institute of V.I. Vernadsky Crimean Federal University

Author for correspondence.
Email: ars-en@yandex.ru

PhD, Associate Professor at the Department of Obstetrics, Gynecology and Perinatology No. 1 of S.I. Georgievsky Medical Institute, V.I. Vernadsky Crimean Federal University; Obstetrician-Gynecologist at the Perinatal Center of N.A. Semashko Republican Clinical Hospital

Russian Federation, Simferopol; Simferopol

Vladislava A. Novikova

Peoples' Friendship University of Russia

Email: kafedra-aig@mail.ru

Dr. Med. Sci., Professor of the Department of Obstetrics and Gynecology with the course of Perinatology, Medical Institute 

Russian Federation, Moscow

Victor E. Radzinsky

Peoples' Friendship University of Russia

Email: kafedra-aig@mail.ru

Dr. Med. Sci., Professor, Corresponding Member of the RAS, Head of the Department of Obstetrics and Gynecology with the course of Perinatology, Medical Institute 

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Structure of risk factors for fetal growth failure: a) in the cohort; b) in the groups

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3. Fig. 2. Interrelated complications of gestation with UUI in principle (a); with VTE or IHF (b)

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4. Fig. 3. Gestational age at delivery: a - in cohort: b, c - in groups

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5. Fig. 4. Frequency of PR in the cohort according to gestational age

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6. Fig. 5. Structure of causes and frequency (%) of PPD in prematurity (a); method of delivery according to the cause of PPD and its type (b)

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7. Fig. 6. Indications for CS (a) and complications of vaginal delivery (b)

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8. Fig. 7. Indications for CS (a) and complications of vaginal delivery (b) according to the cause of IUGR

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9. Fig. 8. Methods of delivery in prematurity

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10. Fig. 9. Distribution of newborns: a) low birth weight by variant and cause of UUI; b) by specific treatment and cause of UUI

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11. Fig. 10. Prognostic significance of predictors of PPH or IHD: a) in the cohort; b) in CS; c) in vaginal delivery

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12. Fig. 11. Predictive significance of predictors of the volume of medical care for a newborn baby

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