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Q&A

Antepartum Fetal Assessment

Poster Session 1

(197) Is umbilical artery Doppler improvement following steroid administration associated with improved fetal growth?

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Betamethasone (BMZ) is given for fetal growth restriction (FGR) with abnormal umbilical artery Doppler (UAD) velocimetry. Improvement of UAD can be seen after BMZ, but the impact on fetal growth and other outcomes is unclear. We tested the hypothesis that UAD improvement after BMZ is associated with improved fetal growth.  

Study Design: This was a retrospective cohort study of pregnancies with FGR from 2014 to 2020 with abnormal UAD between 240-336 weeks gestational age (GA). Abnormal UAD included elevated (pulsatility index >95%ile), absent end diastolic flow (EDF), or reversed EDF. We included patients who received BMZ within 1 week of abnormal UAD and had growth assessments performed before and after BMZ administration. Improvement was defined as any improvement in a category of UAD within 2 weeks of BMZ. The primary outcome was small-for-GA (SGA) at birth. Secondary outcomes included growth trends, GA at delivery, and birthweight. Outcomes were compared between patients with and without UAD improvement after BMZ. Sensitivity analyses among those with sustained and non-sustained UAD improvement and subgroup analysis of absent or reversed EDF were performed. 

Results: Of 102 pregnancies, UAD improved in 58 (59.1%) after BMZ. There was no difference in SGA between the two groups. The initial growth velocity (rate of change in fetal weight (EFW) immediately before and after BMZ administration) was higher in patients with UAD improvement; however there was no difference in final growth velocity (rate of change in EFW from BMZ administration to birth) between groups. Patients with improved UAD delivered at a significantly later GA with higher birthweight. The rate of SGA was similar between those with sustained vs non-sustained UAD improvement and in patients with absent or reversed EDF. 

Conclusion: UAD improved in more than half of FGR cases after BMZ and was associated with initial improvement in growth velocity, but this improvement was not sustained over pregnancy. While UAD improvement after BMZ appears to be associated with improved pregnancy outcomes, the impact on growth patterns seems transient.