Risk Factors for Term or Near-Term Fetal Growth Restriction in the Absence of Maternal Complications

The objective of this study was to examine risk factors for term or near-term fetal growth restriction (FGR) in the absence of pregnancy complications. We completed a survey of uncomplicated single live births delivered in Greater Beirut, Lebanon. FGR cases were defined as below the 10th percentile of expected weight at gestational age. Multivariate logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Main predictors of FGR were female gender (OR, 1.94; 95% CI, 1.46 to 2.59), nulliparity (Or, 1.66; 95% CI, 1.25 ton 2.20), low prepregnancy weight (OR, 2.52; 95% CI, 1.58 to 4.01), short stature (OR, 2.59; 95% CI, 1.57 to 4.28), and low pregnancy weight gain (OR, 1.75; 95% CI, 1.21 to 2.55). Anthropometric characteristics of mothers are important modifiable determinants of fetal size in our developing urban population of uncomplicated births.

KEYWORDS

Fetal growth restriction - pregnancy - epidemiology

REFERENCES

• 1 Bakketeig L S. Current growth standards, definitions, diagnosis and classification of fetal growth retardation.  Eur J Clin Nutr. 1998;  52 S1-S4
• 2 Clausson B, Cnattingius S, Axelsson O. Preterm and term births of small for gestational age infants: a population-based study of risk factors among nulliparous women.  Br J Obstet Gynecol. 1998;  105 1011-1017
• 3 De Onis M, Blössner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries.  Eur J Clin Nutr. 1998;  52 S5-S15
• 4 Kramer M S. Socioeconomic determinants of intrauterine growth retardation.  Eur J Clin Nutr. 1998;  52 S29-S33
• 5 Lapillonne A, Peretti N, Ho P S, Claris O, Salle B L. Aetiology, morphology and body composition of infants born small for gestational age.  Acta Paediatr Suppl. 1997;  423 173-6
• 6 Bates J A, Evans J A, Mason G. Differentiation of growth retarded from normally grown fetuses and prediction of intrauterine growth retardation using Doppler ultrasound.  Br J Obstet Gynaecol. 1996;  103 670-675
• 7 Karlberg J, Albertsson-Wikland K, Baber F M, Low L CK, Yeung C Y. Born small for gestational age: consequences for growth.  Acta Paediatr. 1996;  417(suppl) 8-13
• 8 Bakketeig L S, Jacobson U, Hoffman H J et al.. Prepregnancy risk factors of small-for-gestational age births among parous women in Scandinavia.  Acta Obstet Gynecol Scand. 1993;  72 273-279
• 9 Abrams B, Newman V. Small-for-gestational age at birth: maternal predictors and comparison with risk factors of spontaneous preterm delivery in the same cohort.  Am J Obstet Gynecol. 1991;  164 875-890
• 10 Altman D G, Hytten F E. Intrauterine growth retardation: Let's be clear about it (commentary).  Br J Obstet Gynaecol. 1989;  96 1127-1132
• 11 Wennergren M. Perinatal risk factors: with special reference to intrauterine Growth retardation and neonatal respiratory adaptation.  Acta Obstet Gynecol Scand Suppl. 1986;  135 9-18
• 12 Villar J, De Onis M, Kestler E, Bolanos F, Cerezo R, Bernedes H. The differential neonatal morbidity of the intrauterine growth retardation syndrome.  Am J Obstet Gynecol. 1990;  163 151-157
• 13 Wennergren M, Wennergren G, Vlbergsson G. Obstetric characteristics and neonatal performance in a four-year small for gestatioal age population.  Obstet Gynecol. 1988;  72 615-620
• 14 Nordentolf M, Lou H, Hansen D et al.. Intrauterine growth retardation and premature delivery: the influence of maternal smoking and psychosocial factors.  Am J Public Health. 1996;  86 347-354
• 15 Wen S W, Goldenberg R L, Cutter G R, Hoffman H J, Cliver S P. Intrauterine growth retardation and preterm delivery: prenatal risk factors in an indigent population.  Am J Obstet Gynecol. 1990;  162 213-218
• 16 Wen S W, Goldenberg R L, Cutter G R et al.. Smoking, maternal age, fetal growth, and gestational age at delivery.  Am J Obstet Gynecol. 1990;  162 53-58
• 17 Villar J, Belizan J M. The relative contribution of prematurity and fetal growth retardation to low birth weight in developing and developed societies.  Am J Obstet Gynecol. 1982;  143 793-798
• 18 Becerra J E, Smith J C. Maternal smoking and low birthweight in the reproductive history of women in Puerto Rico, 1982.  Am J Public Health. 1988;  78 268-272
• 19 Fikree F F, Berendes H W. Risk factors for term intrauterine growth retardation: a community-based study in Karachi.  Bull World Health Organ. 1994;  72 581-588
• 20 Guyer B, Hoyert D L, Martin J A, Ventura S J, MacDorman M E, Strobino D M. Annual summary of vital Statistics-1998.  Pediatrics. 1999;  104 1229-1246
• 21 O'Campo P, Xue X, Wang M C, Caughy M O. Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis.  Am J Public Health. 1997;  87 1113-1118
• 22 Golding J, Shenton T. Low birth-weight and pre-term delivery in South-East Asia. The WHO international collaborative study of hypertensive disorders of pregnancy.  Soc Sci Med. 1990;  30 497-502
• 23 Mamelle N, Laumon B, Lazar P. Prematurity and occupational activity during pregnancy.  Am J Epidemiol. 1984;  119 309-322
• 24 Launer L J, Villar J, Kestler E, De Onis M. The effect of maternal work on fetal growth and duration of pregnancy: a prospective study.  Br J Obstet Gynecol. 1990;  97 62-70
• 25 Alexander G R, Himes J H, Kaufman R B, Mor J, Kogan M. A United States national reference for fetal growth.  Obstet Gynecol. 1996;  87 163-168
• 26 George D, Mallery P. SPSS for Windows Step by Step: A Simple Guide and Reference, 11.0 Update. 4th ed. Ontario, Canada; Allyn and Bacon 1999
• 27 Schieve L A, Cogswell M E, Scanlon K S et al.. Prepregnancy body mass index and pregnancy weight gain: association with preterm delivery. The NMLHS Collaborative Study Group.  Obstet Gynecol. 2000;  96 194-200
• 28 Hickey C A, Cliver S P, McNeal S F, Hoffmann H J, Goldenberg R L. Prenatal weight gain patterns and birth weight among nonobese black and white women.  Obstet Gynecol. 1996;  88 490-496
• 29 Abrams B, Altman S L, Pickett K E. Pregnancy weight gain: still controversial.  Am J Clin Nutr. 2000;  71(5 suppl) 1233S-1241S
• 30 Hickey C A, Cliver S P, Goldenberg R L, Kohatsu J, Hoffman H J. Prenatal weight gain, term birth weight and fetal growth retardation among high-risk multiparous black and white women.  Obstet Gynecol. 1993;  81 529-535
• 31 Croall J, Sherrif S, Matthews J. Non-pregnant maternal plasma volume and fetal growth retardation.  Br J Obstet Gynaecol. 1978;  85 90-95
• 32 Gallery E DM, Hunyor S N, Gyory A Z. Plasma volume contraction: a significant factor in both pregnancy associated hypertension (pre-eclampsia) and chronic hypertension in pregnancy.  QJM. 1979;  48 593-602
• 33 Soffronoff E C, Kaufmann B M, Connaughton J F. Intravascular volume determinations and fetal outcomes in hypertensive diseases of pregnancy.  Am J Obstet Gynecol. 1977;  127 4-9
• 34 Salas S P, Rosso P, Espinoza R, Robert J A, Valdes G, Donoso E. Maternal plasma volume expansion and hormonal changes in women with idiopathic fetal growth retardation.  Obstet Gynecol. 1993;  81 1029-1033
• 35 Parti G, Marconi A M, Cetin I. Placental-fetal interrelationship in IUGR fetuses: a review.  Placenta. 2002;  23(suppl A) S136-S141
• 36 Mongelli M, Gardosi J. Fetal growth.  Curr Opin Obstet Gynecol. 2000;  12 111-115