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Q&A

Ultrasound/Imaging

Poster Session 2

(465) Fetal growth restriction: What is worse too small (EFW) or too skinny (AC)?

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

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
HM

Hailey Mcinerney, MD

Mount Sinai West
New York, NY, United States
LA

Lily Ardente, BS

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

Christina Cary, MD

Mount Sinai West
New York, NY, United States
DC

David Cole, MD

Mt. Sinai West
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 fetal growth restriction(FGR) by estimated fetal weight(EFW) or abdominal circumference(AC) < 10%. There is limited data on neonatal outcomes based on FGR diagnosed by EFW vs isolated AC. The SMFM algorithm for the diagnosis and management of FGR does not address managing patients with FGR based on AC. Our objective was to assess whether FGR based on EFW had worse outcomes and perinatal morbidity than those diagnosed solely on AC.

Study Design: This was a retrospective cohort study performed on singleton gestations from 03/2018-12/2022. All patients included, were admitted for induction of labor at term and had a pregnancy with a fetus defined as FGR at the last ultrasound prior to delivery. Group EFW was defined as FGR with overall EFW< 10%; Group AC was defined as FGR with an isolated AC< 10th% and overall EFW≥10%. The primary outcome was a neonatal composite outcome which was defined as: NICU Admission, APGAR < 5 at 5 minutes, neonatal hypoglycemia, and small for gestational age (SGA).

Results: Of the 529 patients eligible, 237(45%) were in the EFW Group and 292(55%) were in the AC Group. The demographic data was similar between the groups. There was a significant difference between the two groups in respect to: gestational age at delivery, neonatal birth percentile, weight & 5 minutes APGARS. The proportion of individuals who had abnormal Dopplers, chronic hypertension, SGA at birth, and NICU admission was significantly higher in EFW vs AC Group (p< 0.0001, See Table 1). Composite neonatal outcomes were significantly worse in the EFW group compared to AC Group (p< 0.0001). The odds of having an adverse outcome among individuals diagnosed as FGR via EFW is 3.88 times higher among neonates diagnosed as FGR via AC (95% CI:2.6–5.8)

Conclusion: Our data suggests that neonates who were diagnosed with FGR based on EFW had worse neonatal outcomes when compared to FGR diagnosed by AC alone. These findings could be used to consult and reassure the patient that while an isolated AC< 10% gives a fetus the diagnosis of FGR, the outcomes appear to be better for these infants.