Clinical and anamnestic risk factors and prediction models for the development of fetal growth restriction
Gasymova S.R., Tyutyunnik V.L., Kan N.E., Volochaeva M.V., Donnikov A.E.
Objective: To analyze clinical and anamnestic risk factors and develop prediction models for early- and late-onset fetal growth restriction.
Materials and methods: A cross-sectional study was conducted at the V.I. Kulakov NMRC for OG&P of Minzdrav of Russia, involving 382 pregnant women. Group 1 included 110 pregnant women with fetal growth restriction, whereas Group 2 included 272 women with pregnancies without fetal growth restriction. An analysis of the somatic and obstetric-gynecological history and course of the current pregnancy in both groups was performed. Prediction models for the likelihood of developing early- and late-onset fetal growth restriction were developed.
Results: In group 1, a history of arterial hypertension [10/110 (9.1%) vs. 6/272 (2.2%), p=0.045, OR=0.226 (95% CI 0.052–0.979)], chronic pyelonephritis [8/110 (7.3%) vs. 2/272 (0.7%), p=0.025, OR=0.094 (95% CI 0.010–0.865)], chronic endometritis [8/110 (7.3%) vs. 58/272 (21.3%), p=0.02, OR=0.82 (95% CI 0.015–10.353)], and a history of giving birth to children with growth restriction in previous pregnancies [8/110 (7.3%) vs. 2/272 (0.7%), p=0.025, OR=0.094 (95% CI 0.010–0.865)] were significantly more common than in group 2. During the current pregnancy, the following complications were significantly more prevalent in group 1 than in group 2: threatened miscarriage [35/110 (31.8%) vs. 64/272 (23.5%), p=0.04, RR=1.97 (95% CI 1.03–3.75)], preeclampsia [11/110 (10%) vs. 9/272 (3.3%), p=0.01, RR=3.53 (95% CI 1.37–9.08)], chronic arterial hypertension [11/110 (10%) vs. 11/272 (4.0%), p=0.02, RR=2.84 (95% CI 1.15–7.01)], and placenta previa [5/110 (4.5%) vs. 5/272 (1.8%), p=0.01, RR=0.84 (95% CI 0.42–1.68)]. Significant predictors of fetal growth restriction included a history of having a child with growth restriction, placenta previa, obesity, and preeclampsia. Based on the identified predictors, mathematical predictive models were developed to determine the likelihood of fetal growth restriction.
Conclusion: The developed predictive models for early- and late-onset fetal growth restriction can help reduce the incidence of pregnancy complications and improve perinatal outcomes.
Authors’ contributions: Gasymova S.R., Volochaeva M.V., Donnikov A.E. – conception and design of the study, data collection and analysis, review of relevant literature, material processing and analysis, statistical analysis; Gasymova S.R., Tyutyunnik V.L., Kan N.E. – drafting and editing of the manuscript.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Gasymova S.R., Tyutyunnik V.L., Kan N.E., Volochaeva M.V., Donnikov A.E.
Clinical and anamnestic risk factors and prediction models for the development of fetal growth restriction.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (10): 52-59 (in Russian)
https://dx.doi.org/10.18565/aig.2024.166
Keywords
fetal growth restriction
clinical and anamnestic risk factors
predictors
prediction models
early-onset fetal growth restriction
late-onset fetal growth restriction
References
- Brosens I., Pijnenborg R., Vercruysse L., Romero R. The «Great Obstetrical Syndromes» are associated with disorders of deep placentation. Am. J. Obstet. Gynecol. 2011; 204(3): 193-201. https://dx.doi.org/110.1016/j.ajog.2010.08.009.
- Ганичкина М.Б., Мантрова Д.А., Кан Н.Е., Тютюнник В.Л., Хачатурян А.А., Зиганшина М.М. Ведение беременности при задержке роста плода. Акушерство и гинекология. 2017; 10: 5-11. [Ganichkina M.B., Mantrova D.A., Kan N.E., Tyutyunnik V.L., Khachaturyan A.A, Ziganshina M.M. Management of pregnancy during fetal growth retardation. Obstetrics and Gynecology. 2017; (10): 5-11. (in Russian)]. https://dx.doi.org/10.18565/aig.2017.10.5-11.
- Priante E., Verlato G., Giordano G., Stocchero M., Visentin S., Mardegan V., Baraldi E. Intrauterine growth restriction: new insight from the metabolomic approach. Metabolites. 2019; 9(11): 267. https://dx.doi.org/10.3390/metabo9110267.
- Sharma D., Shastri S., Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects. Clin. Med. Insights Pediatr. 2016; 10: 67-83. https://dx.doi.org/10.4137/CMPed.S40070.
- Якубова Д.И., Игнатко И.В., Меграбян А.Д., Богомазова И.М. Особенности течения беременности и исходы родов при различных фенотипах задержки роста плода. Акушерство и гинекология. 2022; 8: 54-62. [Yakubova D.I., Ignatko I.V., Megrabian A.D., Bogomazova I.M. Features of pregnancy course and delivery outcomes in various phenotypes of fetal growth restriction. Obstetrics and Gynecology. 2022; (8): 54-62. (in Russian)]. https://dx.doi.org/10.18565/aig.2022.8.54-62.
- Burton G.J, Jauniaux E. Pathophysiology of placental-derived fetal growth restriction. Am. J. Obstet. Gynecol. 2018; 218(2S): S745-61. https://dx.doi.org/10.1016/j.ajog.2017.11.577.
- Hendrix N., Berghella V. Non-placental causes of intrauterine growth restriction. Semin. Perinatol. 2008; 32(3): 161-5. https://dx.doi.org/10.1053/j.semperi.2008.02.004.
- Serin S., Bakacak M., Ercan Ö., Köstü B., Avci F., Arıkan D., Kıran G. The evaluation of Nesfatin-1 levels in patients with and without intrauterine growth restriction. J. Matern. Fetal Neonatal Med. 2016; 29(9): 1409-13. https://dx.doi.org/10.3109/14767058.2015.1049524.
- Tao Z., Chen Y., He F., Tang J., Zhan L., Hu H. et al. Alterations in the gut microbiome and metabolisms in pegnancies with ffetal growth restriction. Microbiol. Spectr. 2023; 11(3): e0007623. https://dx.doi.org/10.1128/spectrum.00076-23.
- Tanner L.D., Brock A C., Chauhan S.P. Severity of fetal growth restriction stratified according to maternal obesity. J. Matern. Fetal Neonatal Med. 2022; 35(10): 1886-90. https://dx.doi.org/10.1080/14767058.2020.1773427.
- Salmeri N., Ca rbone I.F., Cavoretto P.I., Farina A., Morano D. Epigenetics beyond Fetal growth restriction: A comprehensive overview. Mol. Diagn. Ther. 2022; 26(6): 607-26. https://dx.doi.org/10.1007/s40291-022-00611-4.
- Lees C., Marlow N., Arabin B., Bilardo C.M., Brezinka C., Derks J.B. et al; TRUFFLE Group. Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet. Gynecol. 2013; 42 (4): 400-8. https://dx.doi.org/10.1002/uog.
- Allen V.M., Joseph K., Murphy K.E., Magee L.A., Ohlsson A. The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study. BMC Pregnancy Childbirth. 2004; 4(1): 17. https://dx.doi.org/10.1186/1471-2393-4-17.
- Zhang H.G., Yang L., Qiao Z.X., Guo W. Effect of gestational hypertension on fetal growth restriction, endocrine and cardiovascular disorders. Asian J. Surg. 2022; 45 (4): 1048-9. https://dx.doi.org/10.1016/j.asjsur.2022.01.050.
- Пестрикова Т.Ю., Юрасова Е.А., Ткаченко В.А. Плацентарная недостаточность как базовая патология осложнений и исходов гестационного периода. Российский вестник акушера-гинеколога. 2020; 20(1): 5‑15. [Pestrikova T.Iu., Iurasova E.A., Tkachenko V.A. Placental insufficiency as the underlying condition of the complications an outcomes of the gestation period. Russian Bulletin of Obstetrician-Gynecologist. 2020; 20(1): 5‑15. (in Russian)]. https://dx.doi.org/10.17116/rosakush2020200115.
- Тапильская Н.И., Мельников К.Н., Кузнецова И.А., Глушаков Р.И. Плацентарная недостаточность и синдром задержки роста плода: этиология, профилактика, лечение. Медицинский Aлфавит. 2020; 4: 6-10. [Tapilskaya N.I., Mel’nikov K.N., Kuznetsova I.A., Glushakov R.I. Placental insufficiency and fetal growth restiction: etiology, prevention, and treatment. Medical Alphabet. 2020; (4): 6-10. (in Russian)]. https://dx.doi.org/10.33667/2078-5631-2020-4-6-10.
- Diguisto C., Le Gouge A., Marchand M.S., Megier P., Ville Y., Haddad G. et al; Groupe de Recherche en Obstétrique et Gynécologie (GROG). Low-dose aspirin to prevent preeclampsia and growth restriction in nulliparous women identified by uterine artery Doppler as at high risk of preeclampsia: A double blinded randomized placebo-controlled trial. PLoS One. 2022; 17(10): e0275129. https://dx.doi.org/10.1371/journal.pone.0275129.
- Lin L., Guo Y.N., Xu X., Huang L.P., Yang Q.P., Yan J.Y. Analysis of maternal and fetal outcomes and establishment of prediction model of vaginal delivery in pregnant women with pre-eclampsia complicated with fetal growth restriction. Eur. Rev. Med. Pharmacol. Sci. 2023; 27(20): 9947-954. https://dx.doi.org/10.26355/eurrev_202310_34173.
- Saraswat L., Bhattacharya S., Maheshwari A., Bhattacharya S. Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: a systematic review. BJOG. 2010; 117(3): 245-57. https://dx.doi.org/10.1111/j.1471-0528.2009.02427.x.
- Wijesiriwardana A., Bhattacharya S., Shetty A., Smith N., Bhattacharya S. Obstetric outcome in women with threatened miscarriage in the first trimester. Obstet. Gynecol. 2006; 107(3): 557-62. https://dx.doi.org/10.1097/01.AOG.0000199952.82151.de.
- McLindon L.A., James G., Beckmann M.M., Bertolone J., Mahomed K., Vane M. et al. Progester.one for women with threate.ned miscarriage (STOP trial): a pla cebo-controlled randomized clinical trial. Hum. Reprod. 2023; 38(4): 560-8. https://dx.doi.org/10.1093/humrep/dead029.
- Волочаева М.В., Кан Н.Е., Тютюнник В.Л., Амирасланов Э.Ю., Леонова А.А., Солдатова Е.Е. Клинико-анамнестические факторы в прогнозировании и диагностике задержки роста плода. Акушерство и гинекология. 2023; 9: 82-90. [Volochaeva M.V., Kan N.E., Tyutyunnik V.L., Amiraslanov E.Yu, Leonova A.A., Soldatova E.E. Clinical and anamnestic factors in the prediction and diagnosis of fetal growth retardation. Obstetrics and Gynecology. 2023; (9): 82-90. (in Russian)]. https://dx.doi.org/10.18565/aig.2023.9.82-90.
Received 12.07.2024
Accepted 27.09.2024
About the Authors
Shagane R. Gasymova, Junior Researcher, Department of Fetal Medicine of the Institute of Obstetrics; Diagnostic Medical Sonographer, Department of Ultrasound and Functional Diagnostics; Obstetrician-Gynecologist, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(916)542-22-99, shagane2501@mail.ru, https://orcid.org/0009-0001-2626-6670Victor L. Tyutyunnik, Professor, Dr. Med. Sci., Leading Researcher at the Center for Scientific and Clinical Research, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, tioutiounnik@mail.ru,
Researcher ID: B-2364-2015, SPIN-code: 1963-1359, Authors ID: 213217, Scopus Author ID: 56190621500, https://orcid.org/0000-0002-5830-5099
Natalia E. Kan, Professor, Dr. Med. Sci., Deputy Director of Science, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, kan-med@mail.ru, Researcher ID: B-2370-2015, SPIN-code: 5378-8437,
Authors ID: 624900, Scopus Author ID: 57008835600, https://orcid.org/0000-0001-5087-5946
Maria V. Volochaeva, PhD, Senior Researcher at the Department of Regional Cooperation and Integration; Physician at the 1 Maternity Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4,
volochaeva.m@yandex.ru, https://orcid.org/0000-0001-8953-7952
Andrey E. Donnikov, PhD, Head of the Laboratory of Molecular Genetic Methods, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology
and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, donnikov@dna-technology.ru, https://orcid.org/0000-0003-3504-2406
Corresponding author: Shagane R. Gasymova, shagane2501@mail.ru
Similar Articles
