Application of a customised birthweight standard in the assessment of perinatal outcome in a high risk population

Objective Physiological as well as pathological variables influence birthweight. The aim of the present study was to examine perinatal outcome in relation to birthweight centiles applying a customised birthweight standard.
Methods Two hundred and seventeen babies from high risk pregnancies were evaluated and classified as small or not small for gestational age according to two standards: 1. conventional Dutch birthweight centiles and 2. customised centiles which adjust individually for physiological variables like maternal booking weight, height and ethnic origin.
Results Customisation of the weight standards resulted in identification of an additional group of infants who were small for gestational age, but not by the Dutch standards. These babies were associated with significantly more adverse perinatal events than those who were not small for gestational age as defined by a customised standard.
Conclusions Adjustment of birthweight centiles for physiological variables significantly improves the identification of infants who have failed to reach the expected birthweight and who are at increased risk for adverse perinatal events.     

Relationship between customised birthweight centiles and neonatal anthropometric features of growth restriction

Objective To determine the relationship between customised birthweight centiles (adjusted for maternal and fetal physiological variables) and neonatal anthropometric features of intrauterine growth restriction (IUGR).
Design Observational study.
Population Two-hundred and seventy women with low risk pregnancies participating in a cohort study of serial ultrasound biometry.
Methods Customised birthweight centiles were calculated following adjustment for maternal weight, height and ethnic origin, gestational age at delivery, birth order, and sex of the infant. Three separate neonatal anthropometric measures were used to define IUGR: subscapular or triceps skinfold thickness  <10th  centile; ponderal index  <25th  centile; and mid-arm circumference to occipito-frontal circumference ratio (MAC/OFC) <−1 standard deviation (SD). Relationship of the centiles to these outcomes was evaluated using likelihood ratios (LR) and kappa statistic. These approaches allowed us to examine the strength of the association: an LR of 5–10 would be expected to generate moderate changes in the pre-test probability of IUGR, whereas a kappa value of 0.2–0.4 would reflect fair agreement between customised birthweight centiles and neonatal anthropometric measures.
Results Customised birthweight centile of 10 or less had the following LR values for the various anthropometric criteria for IUGR: 5.1 (95% CI 3–8.5) for low skinfold thickness; 4.3 (95% CI 2.5–7.1) for low ponderal index; and 3.9 (95% CI 2–6.6) for low MAC/OFC ratio. The kappa values were: 0.4 (95% CI 0.26–0.51) for low skinfold thickness; 0.33 (95% CI 0.21–0.46) for low ponderal index; and 0.13 (95% CI 0–0.26) for low MAC/OFC ratio.
Conclusion In a low risk population, customised birthweight centiles can only be moderately useful in the identification of neonates with low skinfold thickness and low ponderal index.     

Customised birthweight centiles are useful for identifying small-for-gestational-age babies in women with type 2 diabetes

Background: Customised birthweight centiles identify small-for-gestational-age (SGA) babies at increased risk of morbidity more accurately than population centiles, but they have not been validated in obese populations.
Aims: To compare the rates of SGA by population and customised birthweight centiles in babies of women with type 2 diabetes and examine perinatal outcomes in customised SGA infants.
Methods: Data were from a previous retrospective cohort study detailing pregnancy outcomes in 212 women with type 2 diabetes. Customised and population birthweight centiles were calculated; pregnancy details and neonatal outcomes were compared between groups that delivered infants who were SGA (birthweight < 10th customised centile) and appropriate weight for gestational age (AGA) (birthweight 10–90th customised centile).
Results: Fifteen (7%) babies were SGA by population centiles and 32 (15%) by customised centiles. Two babies of Indian women were reclassified from SGA to AGA by customised centiles. Nineteen babies were reclassified from AGA to SGA by customised centiles; of these, 15 (79%) were born to Polynesian women, five (26%) were born less than 32 weeks and two (11%) were stillborn. Customised SGA infants, compared with AGA infants, were more likely to be born preterm (19 (59%) vs 20 (16%), P  < 0.001) and more likely to be stillborn (4 (13%) vs 0 P  = 0.001). After excluding still births, admission to the neonatal unit was also more common (19 of 28 (68%) vs 43 of 127 (34%), P  < 0.001).
Conclusions: In our population more babies were classified as SGA by customised compared with population centiles. These customised SGA babies have high rates of morbidity.     

Perinatal outcome in SGA births defined by customised versus population-based birthweight standards

Objective To determine whether customised birthweight standard improves the definition of small for gestational age and its association with adverse pregnancy outcomes such as stillbirth, neonatal death, or low Apgar score.
Design Population based cohort study.
Population Births in Sweden between 1992-95 ( n =326,377).
Methods Risks of stillbirth, neonatal death, and Apgar score under four at five minutes were calculated for the lowest 10% birthweights according to population-based and customised standards, and were compared with the data from the group with birthweights over this limit. Population attributable risks for stillbirth using various birthweight centile cutoffs were calculated for the two standards.
Outcome measures Odds ratios and 95% confidence intervals for stillbirth, neonatal death and Apgar score under four at five minutes, and population attributable risks for stillbirth at different birthweight centiles.
Results Risks of stillbirth, neonatal death, and Apgar score under four at five minutes and population attributable risks of stillbirth were consistently higher if 'small for gestational age' was classified by a customised rather than by the population-based birthweight standard. Compared with infants who were not small for gestational age by both standards, the odds ratio for stillbirth was 6.1 (95% CI 5.0-7.5) for small for gestational age by customised standard only, whereas it was 1.2 (95 % CI 0.8-1.9) for small for gestational age by population standard only.
Conclusions Compared with the population-based birthweight standard, a customised birthweight standard increases identification of fetuses at risk of stillbirth, neonatal death and Apgar score under 4 at 5 minutes, probably due to improved identification of fetal growth restriction.     

The value of customised centiles in assessing perinatal mortality risk associated with parity and maternal size

Objective  We wanted to compare customised and population standards for defining smallness for gestational age (SGA) in the assessment of perinatal mortality risk associated with parity and maternal size.
Design  Population-based cohort study.
Setting  Sweden.
Population  Swedish Birth Registry database 1992–1995 with 354 205 complete records.
Method  Coefficients were derived and applied to determine SGA by the fully customised method, or by adjustment for fetal sex only, and using the same fetal weight standard.
Main outcome measure  Perinatal deaths and rates of small for gestational age (SGA) babies within subgroups stratified by parity, body mass index (BMI) and maternal size within the BMI range of 20.0–24.9.
Results  Perinatal mortality rates (PMR) had a U-shaped distribution in parity groups, increased proportionately with maternal BMI, and had no association with maternal size within the normal BMI range. For each of these subgroups, SGA rates determined by the customised method showed strong association with the PMR. In contrast, SGA based on uncustomised, population-based centiles had poor correlation with perinatal mortality. The increased perinatal mortality risk in pregnancies of obese mothers was associated with an increased risk of SGA using customised centiles, and a decreased risk of SGA using population-based centiles.
Conclusion  The use of customised centiles to determine SGA improves the identification of pregnancies which are at increased risk of perinatal death.     

Restricted fetal growth in sudden intrauterine unexplained death

BACKGROUND: Unexplained antepartum stillbirth is a common cause of perinatal death, and identifying the fetus at risk is a challenge for obstetric practice. Intrauterine growth restriction (IUGR) is associated with a variety of adverse perinatal outcomes, but reports on its impact on unexplained stillbirths by population-based birthweight standards have been varying, including both unexplained and unexplored stillbirths. AIM: We have studied IUGR, assessed by individually adjusted fetal weight standards, in antepartum deaths that remained unexplained despite thorough postmortem investigations. METHODS: Antenatal health cards from a complete population-based 10-year material of 76 validated sudden intrauterine unexplained deaths were compared to those of 582 randomly selected liveborn controls. Birthweight <10th percentile of the individualized standard adjusted for gestational age, maternal height, weight, parity, ethnicity, and fetal gender was defined as growth restriction. RESULTS: 52% of unexplained stillbirths were growth restricted, with a mean gestational age at death of 35.1 weeks. Suboptimal growth was the most important fetal determinant for sudden intrauterine unexplained death (odds ratio 7.0, 95% confidence interval 3.3-15.1). Concurrent maternal overweight or obesity, high age, and low education further increase the risk. Overweight and obesity increase the risk irrespective of fetal growth, and while high maternal age increases the risk of the normal weight fetus, it is not associated to growth restriction as a precursor of sudden intrauterine unexplained death. CONCLUSIONS: IUGR is an important risk factor of sudden intrauterine unexplained death, and this should be excluded in pregnancies with any other risk factor for sudden intrauterine unexplained death.     

Fetal growth restriction and other risk factors for stillbirth in a New Zealand setting

BACKGROUND: Stillbirth affects almost 1% of pregnant women in the Western world but is still not a research priority. AIMS: To assess in a cohort of stillbirths: the demographic risk factors, the prevalence of small for gestational age (SGA) by customised and population centiles, and the classification of death using the Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ-PDC). METHODS: The study population comprised 437 stillborn babies (born from 1993 to 2000 at National Women's Hospital, Auckland, New Zealand) and their mothers. The referent population for demographic factors was live births n=69 173. RESULTS: After multivariable analysis, risk factors for stillbirths were: Indian (odds ratio (OR) 1.85, 95%CI (1.18, 2.91)), or Pacific Islander (OR 1.65, 95%CI (1.27, 2.14)); smoking (OR 1.33, 95%CI (0.99, 1.79)) or unknown smoking status (OR 2.87, 95%CI (2.30, 3.58)); nulliparity (OR 1.42, 95%CI (1.10, 1.83)), and para 2 (OR 1.36, 95%CI (1.01, 1.83)). One hundred and twenty-nine (46%) stillbirths born>or=24 weeks (n=278) were SGA by customised, and 94 (34%) by population centiles. Customised SGA was more common in preterm versus term stillbirths (101 of 198 (51%) vs 28 of 80 (35%), respectively, P=0.02) but rates of population SGA did not differ (72 of 198 (36%) vs 22 of 80 (28%) P=0.16). 'Spontaneous preterm' was the most common cause of stillbirth at <28 weeks and 'unexplained' at >or=28 weeks using PSANZ-PDC classification. CONCLUSIONS: This study again emphasises the importance of suboptimal fetal growth as an important risk factor for stillbirth. Customised centiles identified more stillborn babies as SGA than population centiles especially preterm.     

Customised fetal growth chart: a systematic review.

Customised fetal growth chart is used to individualise fetal weight for gestational age by adjusting for physiological variables known to affect birth weight and growth. Compared with the standard population-based growth chart, the customised growth chart allows for better distinction between normal and abnormal smallness and reduces the false positive and false negative diagnosis of fetal growth restriction. The charts are currently being introduced into clinical practice in the West Midlands as well as in several units around the country. A Medline and systematic review search from 1980 to 2004 was performed in order to collect information and evidence on the use of customised growth chart and its effect on perinatal outcome.     

The relation of maternal serum eNOS,NOSTRIN and ADMA levels with aetiopathogenesis of preeclampsia and/or intrauterine fetal growth restriction

Objective: The aim of present study was to assess the maternal serum endothelial nitric oxide synthase (eNOS), NOSTRIN (eNOS-trafficking inducer) and asymmetric dimethylarginine (ADMA) levels in pregnancies with intrauterine growth restriction (IUGR) in the presence or absence of preeclampsia and to compare the results with preeclamptic pregnant women with appropriate-for-gestational-age weight infants.

Patients and methods: The study was performed on 65 normotensive pregnant women with isolated IUGR, 64 preeclamptic women with IUGR, 51 preeclamptic women with normal intrauterine fetal growth and 65 healthy normotensive pregnant women with singleton uncomplicated pregnancies. Severe preeclampsia was defined as blood pressure >?160/110?mmHg with proteinuria >?5?g in a 24-h urinary protein excretion. IUGR were classified when the weight of the fetus was below the 10th centiles with disturbed placental function and abnormal ultrasonographic examination. The diagnosis was confirmed by the infant's weight at birth. The maternal serum eNOS, NOSTRIN and ADMA concentrations were determined using a sandwich enzyme-linked immunosorbent assays.

Results: There were no statistically significant differences in the eNOS and NOSTRIN levels between studied groups of women. Increased levels of ADMA in both preeclamptic groups and in women with pregnancies complicated by isolated IUGR were observed.

Conclusions: Our results allow the conclusion that impaired NO bioavailability in pregnancies complicated by severe preeclampsia and/or IUGR result not from a reduced level or activity of eNOS or from its disturbed intracellular transport, but from increased ADMA levels, an endogenous inhibitor of the enzyme eNOS.     

The use of customised versus population-based birthweight standards in predicting perinatal mortality

OBJECTIVE: The objective of this study was to critically examine potential artifacts and biases underlying the use of 'customised' standards of birthweight for gestational age (GA). DESIGN: Population-based cohort study. SETTING: Sweden. POPULATION: A total of 782,303 singletons > or =28 weeks of gestation born in 1992-2001 to Nordic mothers with complete data on birthweight; GA; and maternal age, parity, height, and pre-pregnancy weight. METHODS: We compared perinatal mortality in four groups of infants based on the following classification of small for gestational age (SGA): non-SGA based on either population-based or customised standards (the reference group), SGA based on the population-based standard only, SGA based on the customised standard only, and SGA according to both standards. We used graphical methods to compare GA-specific birthweight cutoffs for SGA using the two standards and also used logistic regression to control for differences in GA and maternal pre-pregnancy body mass index (BMI) in the four groups. MAIN OUTCOME MEASURES: Perinatal mortality, including stillbirth and neonatal death. RESULTS: Customisation led to a large artifactual increase in the proportion of SGA infants born preterm. Adjustment for differences in GA and maternal BMI markedly reduced the excess risk among infants classified as SGA by customised standards only. CONCLUSION: The large increase in perinatal mortality risk among infants classified as SGA based on customised standards is largely an artifact due to inclusion of more preterm births.     

Symphysial-Fundal Height from 12 Weeks' Gestation

Summary: There is a strong association between birth-weight and perinatal mortality and morbidity. Intrauterine growth retardation (IUGR) is an important cause of perinatal morbidity and mortality and 50% of cases occur in low risk patients. Despite an obvious need, the diagnosis of IUGR by clinical means has remained difficult and inaccurate. To aid this diagnosis a graph of symphysial-fundal height, based on a local population in Australia, is presented. When used in conjunction with standard charts showing centiles of birth-weight for gestational age, an estimate of fetal weight may be simply and quickly made. When tested in 49 pregnancies the mean error of predicted birth-weight was 86 ±pM 67 gm/Kg.     

Cord blood intestinal fatty acid-binding protein (I-FABP) in full-term intrauterine growth restricted pregnancies

Objective: To prospectively investigate cord blood concentrations of intestinal fatty acid-binding protein-[I-FABP, a useful marker in the early detection of necrotizing enterocolitis-(NEC)] in full-term intrauterine-growth-restricted-(IUGR, associated with NEC, regardless of gestational age) and appropriate-for-gestational-age-(AGA) pregnancies. We also aimed to determine cord blood I-FABP concentrations in IUGR cases with abnormal versus normal antenatal Doppler results and investigate a possible association with feeding intolerance or NEC.Methods: I-FABP concentrations were determined by ELISA in 154 mixed arteriovenous cord blood samples from IUGR (n = 50) and AGA (n = 104) singleton full-term infants.Results: Cord blood I-FABP concentrations did not differ between IUGR and AGA groups, as well as between IUGR infants with normal versus abnormal(however, lacking absent/ reversed end-diastolic umbilical artery flow) antenatal Doppler results. No infant presented with feeding intolerance or NEC. Customized centiles were lower in IUGR infants with abnormal versus normal antenatal Doppler results (p < 0.001). Conclusions: Full-term IUGR infants present with normal cord blood I-FABP concentrations and do not seem to be at higher risk for developing feeding intolerance or NEC, including those with compromised fetal perfusion.     

Intrauterine growth restriction impacts tolerance to total parenteral nutrition in extremely low birth weight infants.

BACKGROUND: Hepatobiliary dysfunction is well recognized as a complication of long-term total parenteral nutrition (TPN). Because intrauterine growth restriction (IUGR) alters a number of metabolic and physiologic variables in the fetus that probably affect the hepatocyte function and tolerance to feedings in the IUGR extremely low birth weight (ELBW), we hypothesized that this group of babies would have an increased incidence of TPN-associated cholestasis and chronic liver failure. METHODS: We performed a review of all ELBW infants (birth weight <1000 g) that received TPN for >7 days. RESULTS: Among 1768 infants admitted to the neonatal intensive care unit there were 103 ELBW who received TPN >7 days, 38 (37%) of them developed TPN cholestasis. Among 69 appropriate for gestational age (AGA)-ELBW infants, 19 (27%) developed cholestasis compared to 19/34 small for gestational age (SGA)-ELBW infants (56%) (p<0.0009). Maximum direct bilirubin values and days on TPN were similar in both groups. SGA-ELBW infants had an increased incidence and earlier onset of cholestasis when compared to AGA-ELBW patients. Liver biopsies and/or autopsies of infants that developed liver failure (four AGA/four SGA) showed extensive sinusoidal/portal fibrosis compatible with "TPN lesion". In the other 30 cases, liver function eventually returned to normal after TPN discontinuation. CONCLUSIONS: When compared, SGA-ELBW infants who received TPN >7 days, despite being more mature than AGA-ELBW infants, have an increased risk for TPN cholestasis and developed this complication earlier in life. However, the incidence of chronic liver failure was not different in these two groups.     

Intrauterine growth restriction and oligohydramnios among high-risk patients

The purposes of this study were (1) to determine the prevalence of oligohydramnios (amniotic fluid index < 5.0 cm) among fetuses with intrauterine growth restriction (IUGR) and newborns identified as small for gestational age (SGA), and (2) among fetuses with IUGR, to determine the predictive accuracy of amniotic fluid index (AFI) < or = versus > 5.0 cm for adverse peripartum outcomes. This was a retrospective review of high-risk pregnancy that had reliable gestational age (GA) and needed weekly biophysical profile (BPP). Along with 95% confidence intervals (CIs), we calculated the likelihood ratios (LRs) and used guidelines promulgated by Evidence-Based Medicine Working Group. Among the 1859 singletons undergoing BPP, IUGR (estimated fetal weight < 10% for GA) was suspected in 22% (n = 410) and the prevalence of oligohydramnios was 6% (95% CI, 4 to 8%). SGA (birthweight < or = 10%) occurred among 28% (n = 517) of newborns and oligohydramnios was noted in 6% (95% CI, 4 to 8%). Among fetuses with IUGR, the LR of oligohydramnios to predict cesarean delivery for nonreassuring fetal heart tracing was 2.0 (range, 0.8 to 5.0); for newborns small for gestational age, 1.9 (range, 1.2 to 3.1), and for neonatal intensive care unit admission, 1.4 (range, 0.6 to 2.3) More than 90% of patients with IUGR or SGA have AFI > 5.0 cm, and oligohydramnios with IUGR is a poor predictor of peripartum complications.     

Fetal growth restriction and other factors associated with neonatal death in New Zealand

BACKGROUND: There are few studies of risk factors for neonatal death in Australia or New Zealand. AIMS: To assess in a cohort of neonatal deaths (i) the demographic and clinical risk factors; (ii) the relationship between low weight for gestation using population and customised centiles; and (iii) the cause of death by the Perinatal Society of Australia and New Zealand Perinatal and Neonatal death classifications. METHODS: A retrospective study of 410 babies who died, in the neonatal period, at National Women's Hospital, between 1993 and 2000. Demographic and clinical data were compared with that from a referent population of live births with neonatal deaths removed (n=68 905). RESULTS: The overall neonatal death rate was 5.9 per 1000 live births and after exclusion of congenital abnormalities was 3.9 per 1000 live births. Infants of Maori women had increased risk compared to European (adjusted odds ration (AOR) 1.52; 95% CI 1.06, 2.18), as did those born to primipara (AOR 1.52; 95% CI 1.10, 2.11), mothers with >or=1 previous low-birthweight baby (AOR 2.97; 95% CI 1.99, 4.44), >or=1 miscarriage (AOR 1.35; 95% CI 1.00, 1.81), and an index multiple pregnancy (AOR 10.51; 95% CI 8.04, 13.76). Infants of Chinese mothers had decreased risk (AOR 0.42; 95% CI 0.18, 0.96). Fifty (34%) babies were small for gestational age by customised and 26 (17%) by population centiles. The most common classification of neonatal death was congenital abnormality (34.6%), followed by extreme prematurity (34.1%). CONCLUSIONS: This study emphasises the importance of suboptimal fetal growth as an important risk factor for neonatal death especially when customised centiles are used.     

Birthweights in sickle cell trait pregnancies

Objectives  Available evidence on the effect of sickle cell trait (SCT) on birthweight is conflicting, not gestational age specific, and does not account for maternal and infant factors. The objectives of this study are to determine the contemporary mean birthweight, mean customised birthweight centile, and to analyse the risk of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) babies in SCT pregnancies.
Design  Large retrospective cohort study.
Setting  London hospital.
Population  Singleton pregnancies between 24 and 42 completed weeks delivered between 2000 and 2005 in parturient with body mass index between 18.0 and 35.0 kg/m².
Methods  All qualifying pregnancies were identified on Terra Nova Healthware. Birthweight centiles of these cases were computed with Gardosi customised bulk centile calculator using collected data on maternal height, weight, ethnicity and parity, and the infant's gender, gestational age and birthweight. Birthweight and birthweight centiles of SCT and pregnancies with no haemoglobinopathy (control) were compared. Statistical analysis was performed using Stata version 9.2.
Main outcome measures  Birthweight and birthweight centiles.
Results  Five hundred and five SCT and 16 320 controls were analysed. The mean birthweight of SCT pregnancies was 3223 g, 57 g lower than controls ( P = 0.024). However, its mean birthweight centile was 49.0% similar to that of controls' 47.5% ( P = 0.320). There is an apparent risk of LGA babies in SCT pregnancies, but logistic regression analysis suggests that the odds are related to being an older non-white parturient and a male infant rather than SCT status.
Conclusions  SCT is not a risk factor for SGA or LGA infants.     

The individual fetal weight/estimated placental weight ratios in monochorionic twins with selective intrauterine growth restriction

OBJECTIVES: To evaluate the individual fetal weight/estimated placental weight ratios (F/P ratio) of the two fetuses in monochorionic (MC) twins with selective intrauterine growth restriction (IUGR). MATERIAL AND METHODS: MC twin with selective IUGR was defined as an estimated fetal weight below the 10th percentile in one twin of MC pregnancy. The estimated individual placental weight was obtained by cutting the placenta along the vascular equator into two territories. A total of 15 MC twins with selective IUGR and 18 MC twins without selective IUGR were included in this study. RESULTS: The individual F/P ratio in the IUGR twin is significantly higher than that in the appropriate for gestational age (AGA) one in MC twin with selective IUGR (6.4 vs 4.0 respectively, p < 0.001). In MC twin without IUGR, the F/P ratios are not significantly different between the two fetuses (5.4 vs 5.1, respectively). CONCLUSION: The high F/P ratio in the IUGR twin in MC with selective IUGR may be due to the placental reserve phenomenon, so that a smaller placental territory may suffice to perfuse the IUGR twin. In other words, in MC twin gestations with an IUGR twin, the fetal weights are not proportional to the placental masses.     

Neuropathology associated with stillbirth

Neuropathologic findings in stillbirths oftentimes provide insight into the specific mechanisms leading to death. Examination of the brains of stillborn infants may also identify pathophysiologic processes that result in prenatal brain injury in liveborn as well as stillborn infants and that lead to neurologic disorders in liveborn infants, such as cerebral palsy or the sudden infant death syndrome (SIDS). A variety of abnormalities are found in the brains of stillborns, the most common including cerebral white matter necrosis (periventricular leukomalacia) or gliosis, germinal matrix or intraventricular hemorrhage, cerebral infarcts, pontosubicular necrosis, and spinal cord or brainstem necrosis. The 2 major hypotheses that have been proposed for the pathophysiology of cerebral white matter injury in the perinatal period are hypoxia/ischemia and infection/cytokines as the basis for injury. The fetal brain may be selectively vulnerable to various insults at specific stages of development.     

Evaluation of the effectiveness of a low-dose aspirin in the treatment of intrauterine growth retardation (IUGR)]

OBJECTIVE: To evaluate the benefits of IUGR treatment by low doses of acetylsalicylic acid (ASA) (1.5 mg/kg) compared to the standard method. The study was based on the reports that aspirin at low doses shifts prostacyclin/tromboxan A2 balance to the dominance of prostacyclin by inhibiting cyclooxygenase activity in platelets, which results in the improvement of the utero-placental circulation. MATERIAL AND METHOD: 31 pregnant women with diagnosed fetal IUGR were randomly assigned to two groups, receiving either low-dose ASA (n = 22) or the standard treatment (Sadamin, Partusisten, glucose i.v., amino acids i.v.) for 10 days. Ultrasound examination of the biometric parameters of the fetus (BPD, AC, FL) was performed and estimated fetal weight (EFW) calculated before and after treatment. The birthweight of infants in the two examined groups was compared. RESULTS: The mean increase in EFW was higher in the aspirin-treated group compared to that receiving standard treatment (478 g vs 246 g, p < 0.05). In all the biometric parameters under study a higher increase was noted in the group with aspirin treatment; however, the difference was not statistically significant. The mean birthweight was found to be higher in the ASA group as well (2856 g vs 2511 g). The frequency of small-for-gestational-age (SGA) infants (birth weight below 10th percentile) was lower in the ASA group than in the controls (27% vs 55%). The low-dose aspirin therapy did not produce any adverse side-effects either among mothers of infants. CONCLUSION: The treatment with low doses of aspirin reduces the proportion of SGA babies and increases birthweight in the case of a diagnosed fetal growth retardation. Since the number of subjects in this study was relatively small, further clinical trials are necessary to evaluate the effectiveness of IUGR treatment by low-dose aspirin.     

Confined placental mosaicism as a risk factor among newborns with fetal growth restriction

OBJECTIVE: To delineate the frequency and clinical presentation of confined placental mosaicism (CPM) among newborns with idiopathic intrauterine growth restriction (IUGR) as compared to infants with appropriate fetal growth. METHODS: 70 newborns with IUGR (birth weight < 10%) were matched by maternal age (+/-5 years) and gestational age (+/-7 days) to an equal number of infants of normal size. From both populations, placental samples underwent karyotype analysis following standard culture. RESULTS: CPM occurred significantly more often in the placentas from IUGR infants compared to controls, 11/70 (15.7%) and 1/70 (1.4%) respectively (p = 0.008). High-level tetraploidy (>20% in a primary culture) predominated among the IUGR placentas, while autosomal aneuploidy occurred only once in each population. Placental histology revealed significantly greater decidual vasculopathy, infarction, and intervillous thrombus formation in the karyotypically abnormal placentas (p = 0.03). Maternal age, gestational age at delivery, degree of growth restriction and ponderal index did not vary with the presence of CPM. CONCLUSION: CPM, and principally high-level tetraploidy, is found significantly more often among the placentas of newborns with IUGR. Infants with IUGR and CPM are clinically diverse although the placentas display pathologic changes suggestive of chronic impairment of uteroplacental function.