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Fetus

Poster Session 2

(602) Fetal ‘late bloomers’ – factors and outcomes associated with apparent resolution of fetal growth restriction

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To evaluate characteristics associated with apparent resolution of fetal growth restriction (FGR) and assess risk of adverse pregnancy outcomes (APO) among those with resolution

Study Design: Passive prospective cohort analysis of singleton non-anomalous pregnancies meeting Delphi consensus-based FGR criteria at a single academic tertiary care institution 2011-2020. FGR resolution was defined as a birthweight ³3rd centile in combination with a lapse of  ≥3 weeks between the last ultrasound meeting consensus criteria for FGR and delivery. The primary composite APO includes perinatal demise and/or poor condition at birth: 5-min Apgar< 7, cord pH ≤7.10, or base excess ≥12. Regression analyses were undertaken to identify factors associated with FGR resolution and those associated with the primary outcome.

Results: Of 901 pregnancies meeting Delphi consensus criteria for FGR, ongoing sonographic surveillance revealed apparent resolution of FGR in 74 (8%) pregnancies. The median time since FGR criteria was last met and delivery was 5.9 (IQR 4.2, 8.0) weeks. Resolution was more likely among those with isolated abdominal circumference < 3rd centile at diagnosis (RR 2.90, 95%CI 1.87-4.49). Those with hypertensive disorders of pregnancy (RR 0.21, 95%CI 0.10-0.41), male fetal sex (RR 0.37, 95%CI 0.22-0.63), and absent/reversed umbilical artery end-diastolic flow at the time of FGR diagnosis (RR 0.09, 95%CI 0.01-0.61) were less likely to have resolution. 173/901 pregnancies (19%) had APO: 5/74 (7%) with apparent resolution of FGR vs 168/827 (20%) without (RR 0.33, 95%CI 0.14-0.78). We failed to find an independent association between resolution of FGR and APO (Figure).

Conclusion:

We identified four characteristics associated with apparent resolution of FGR and found no evidence its resolution is associated with APO. Further investigation in cohorts with more cases of FGR resolution is warranted. Confirmation of our findings would provide evidence that rigorous antenatal testing for these pregnancies may be safely discontinued and indicate risks associated with their iatrogenic early delivery safely avoided.