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Ultrasound/Imaging

Poster Session 3

(850) Timing of the Diagnosis of Fetal Growth Restriction: Better Early or Better Late?

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Olivia Grubman, MD,MPH

Mount Sinai West
New York, NY, United States

Coauthor(s)

Thomas Owens, MD

Dr Thomas Owens
Mount Sinai West
New York, NY, United States
Mia A. Heiligenstein, MD

Resident
Stony Brook University Hospital
Amityville, NY, United States
KW

Kelly Wang, MPH

Icahn School of Medicine at Mount Sinai
New York, NY, United States
GA

Graham Ashmead, MD

Roosevelt Hospital
New York, NY, United States
ZA

Zainab Al-Ibraheemi, MD

Mount Sinai West
N Caldwell, NJ, United States
LB

Lois Brustman, MD

St. Luke's Roosevelt Hospital Center
New York, NY, United States

Objective: SMFM defines early-onset fetal growth restriction(FGR) when diagnosed < 32 weeks(wks) of gestation. The implication of the gestational age(GA) at the time of diagnosis of FGR (based on estimated fetal weight(EFW) or abdominal circumference(AC)) in regards to neonatal outcomes is unclear. The objective of the study was to assess whether the severity of neonatal outcomes was associated with the GA at the time of diagnosis of FGR.

Study Design: A retrospective cohort study, from 3/2018-12/2022, on singleton gestations, with FGR, delivered at term. Fetuses were stratified into groups based on GA at diagnosis: < 24 wks, 24-32 wks, and >32 wks. Groups were further stratified into FGR based on overall EFW< 10% and those that were diagnosed based on an isolated AC< 10th%. The primary outcome was a neonatal composite outcome: NICU Admission, APGAR < 5 at 5 minutes, neonatal hypoglycemia & small for GA.

Results: Of 529 patients, 20 patients were diagnosed with FGR < 24 wks (17 by EFW, 3 by AC), 126 diagnosed 24-32 wks (78 by EFW, 48 by AC) & 382 diagnosed >32 wks (141 by EFW, 241 by AC). Individuals diagnosed at < 24 weks had a higher likelihood of having an adverse event compared to individuals who were diagnosed at GA >32 wks (90% vs. 60.5%, p=0.0003). In regards to the 24-32 wks group, there was no statistically significant difference in the composite outcomes when compared to < 24 wks or >32 wks groups. Furthermore, regardless of the mode of diagnosis (EFW vs AC) there were more adverse composite neonatal outcomes when FGR was diagnosed < 24 wks compared to >32 wks (Table 1). There is a trend of improvement of outcomes in the 24-32 wks period, but it does not reach statistical significance.

Conclusion: Our data implies that the diagnosis of FGR, at any GA, regardless of the mode of diagnosis, is associated with neonatal morbidity of >50%. However, those infants diagnosed < 24 weeks GA, have a significantly higher risk of morbidity than any other GA. Therefore, it is our contention that the definition of early FGR should be expanded upon to reflect the severity of the disease at this periviable time.