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Fetus

Poster Session 4

(954) Second Trimester Fetal Growth Restriction and Small for Gestational Age

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Among individuals with fetal growth restriction (FGR) diagnosed in the mid second trimester (18-24 weeks), we assessed risk factors and associated outcomes with and without small for gestational (SGA).

Study Design: This was a single center retrospective study (1/2018 – 2/2021) of singletons with FGR (estimated weight [EFW] and/or abdominal circumference [AC] < 10th percentile for gestational age, Hadlock) identified at 18 – 24 weeks' with reliable estimated delivery date. We compared maternal and pregnancy characteristics as well as outcomes in pregnancies that were SGA (< 10% birth weight, by Fenton) versus not SGA (10-99% birthweight). We excluded anomalous gestations and those without delivery outcomes. Primary outcome was a composite neonatal outcome including neonatal intensive care unit admission (NICU), respiratory distress syndrome, mechanical ventilation, continuous positive airway pressure, hypoglycemia or neonatal death prior to discharge. Secondary outcomes included other neonatal and maternal outcomes.

Results: During the study period, 28,703 ultrasounds were performed between 18 – 24 weeks' gestation, with 398 (1.4%) singleton gestations diagnosed with FGR. 159 patients (39.9%) met all inclusion criteria. Of these, 78 (49.1%) were not SGA at delivery and 81 (50.9%) were SGA. Maternal characteristics were similar between groups. Those with SGA at delivery were more likely to have EFW ≤ 3rd percentile at diagnosis than those not SGA. The primary outcome occurred more frequently in those SGA at delivery (24.7% not SGA vs. 52.9% SGA, p < 0.001), likely driven by gestational age difference at delivery. Maternal hypertensive disorders of pregnancy occurred more frequently in those SGA (17.9% not SGA vs. 33.3% SGA; p=0.03).

Conclusion:

1 in 2 patients diagnosed with FGR at 18 – 24 weeks' gestation will be SGA at delivery. Fetuses diagnosed with FGR having an EFW ≤ 3rd percentile are more likely to be SGA at delivery. These pregnancies are also more likely to be associated with maternal hypertensive disorders of pregnancy.