Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study.
OBJECTIVE
To assess the proportion of small for gestational age (SGA) and normal birthweight infants suspected of fetal growth restriction (FGR) during pregnancy, and to investigate obstetric and neonatal outcomes by suspicion of FGR and SGA status at birth.


DESIGN
Population-based study.


SETTING
All French maternity units in 2010.


POPULATION
Representative sample of singleton births (n = 14,100).


METHODS
We compared SGA infants with a birthweight of less than the 10th percentile suspected of FGR, defined as mention of FGR in medical charts (true positives), non-SGA infants suspected of FGR (false positives), SGA infants without suspicion of FGR (false negatives) and non-SGA infants without suspicion of FGR (true negatives). Multivariable analyses were adjusted for maternal and neonatal characteristics hypothesised to affect closer surveillance for FGR and our outcomes.


MAIN OUTCOME MEASURES
Obstetric management (caesarean, provider-initiated preterm and early term delivery) and neonatal outcomes (late fetal death, preterm birth, Apgar score, resuscitation at birth).


RESULTS
21.7% of SGA infants (n = 265) and 2.1% of non-SGA infants (n = 271) were suspected of FGR during pregnancy. Compared with true negatives, provider-initiated preterm deliveries were higher for true and false positives (adjusted risk ratio [aRR], 6.1 [95% CI, 3.8-9.8] and 4.6 [95% CI, 3.2-6.7]), but not for false negatives (aRR, 1.1 [95% CI, 0.6-1.9]). Neonatal outcomes were not better for SGA infants if FGR was suspected.


CONCLUSION
Antenatal suspicion of FGR among SGA infants was low and one-half of infants suspected of FGR were not SGA. The increased risk of provider-initiated delivery observed in non-SGA infants suspected of FGR raises concerns about the iatrogenic consequences of screening.
['Monier|I|I|', 'Blondel|B|B|', 'Ego|A|A|', 'Kaminiski|M|M|', 'Goffinet|F|F|', 'Zeitlin|J|J|']
D000328:Adult D001034:Apgar Score D001724:Birth Weight D036861:Delivery, Obstetric D005189:False Positive Reactions D005260:Female D005317:Fetal Growth Retardation D005602:France D005865:Gestational Age D006801:Humans D007231:Infant, Newborn D007236:Infant, Small for Gestational Age D011247:Pregnancy D011256:Pregnancy Outcome D011296:Prenatal Diagnosis
Antenatal detection fetal growth restriction obstetric management small for gestational age