Prediction of fetal growth restriction in high-risk pregnant women

Objective. To develop an individualized comprehensive examination system for pregnant women for the prediction, early diagnosis, and prevention of fetal growth restriction (FGR) based on the assessment of clinical, anamnestic, laboratory, and instrumental risk factors for reduction of perinatal morbidity and mortality. Subjects and methods. In accordance with the goal set, the authors conducted a comprehensive prospective survey of 184 pregnant women in the first trimester of gestation, 184 newborns and also analyzed the perinatal and maternal outcomes of pregnancy. A study group consisted of 146 women whose pregnancy was complicated by placental insufficiency and resulted in the birth of living babies with FGR; a comparison group included 38 women whose pregnancy had no signs of placental insufficiency and resulted in the birth of full-term living babies. Social and marital status, place of residence; bad habits (smoking, use of alcohol and narcotics); somatic and obstetric/ gynecological histories; course of the current pregnancy; characteristics of delivery; and neonatal status were assessed. The results of the first perinatal screening were assessed and the first-trimester levels of serum markers for FGR (PAPP-A, beta-hCG, IGF-1, and vitamin D) were measured in both groups. The pregnant women also underwent comprehensive dynamic ultrasound fetometric, placentographic, and Doppler studies of blood flow in the uterine arteries, umbilical artery, fetal middle cerebral artery, and fetal aorta. Results. A regression-factor analysis was carried out to estimate the importance of each of the studied risk factors in developing FGR. After analyzing all the risk factors, the authors could identify a set of the most important factors. The most important factor proved to be IGF-1 level, and the least important one was β-hCG levels, parity, and first-trimester abortions in previous pregnancies. The group of negative factors included the levels of β-hCG, vitamin D (1,25(OH)2D), anemia, and kidney diseases. That of positive factors involved parity, threatened miscarriage, IGF-1 levels, and first-trimester abortions in previous pregnancies. Conclusion. Thus, the comprehensive clinical, instrumental, and laboratory study of pregnant women at high risk for FGR provides an opportunity not only to timely diagnose these complications, but also to predict with a significant possibility their development just at pregravid stage, which will be able to implement a package of preconceptional corrective measures.

fetal growth restriction, high-risk pregnant women