Third trimester growth restriction patterns: individualized assessment using a fetal growth pathology score.
OBJECTIVE
To qualitatively and quantitatively characterize third trimester growth patterns in fetuses/neonates with growth restriction using Individualized Growth Assessment.


METHODS
Serial fetal size measurements from 73 fetuses with proven growth restriction were evaluated using a novel composite parameter, the Fetal Growth Pathology Score (FGPS1). Third trimester FGPS1 measurements plotted against fetal age were examined for patterns. Identified patterns were characterized using the four components of the FGP1 [head circumference (HC), abdominal circumference (AC), femur diaphysis length (FDL), estimated weight (EWT)]. A secondary characterization using age of onset, duration and magnitude of the growth abnormality process was also performed. Frequencies and magnitudes of abnormal values in different FGPS1 patterns were compared.


RESULTS
Five growth restriction patterns were found in 70/73 (95.9%) of the cases, with progressive worsening [Pattern 1 (37.0%)] and abnormal growth identified only at last scan [Pattern 2 (27.4%)] being the most common. These two patterns were usually statistically different from each other and the other three with respect to size parameter abnormalities and abnormal growth process characteristics (MANOVA). Growth abnormalities in all parameters of the FGPS1 contributed to the five abnormality patterns although AC and EWT were most important. The age of onset, duration and magnitude were similar between patterns except for Pattern 2, which had a late onset and a short duration (GLM + contrasts).


CONCLUSIONS
Our study represents the first detailed evaluation of third trimester growth restriction using methods that consider the growth potential of each fetus. Five distinctive and repetitive patterns were found, suggesting that fetal growth restriction evolves in different ways. Further research is needed to determine the relationships of these patterns to physiological/biochemical changes and adverse outcomes associated with growth restriction.
['Deter|Russell L|RL|', 'Lee|Wesley|W|', 'Sangi-Haghpeykar|Haleh|H|', 'Kingdom|John|J|', 'Romero|Roberto|R|']
D005260:Female D047109:Fetal Development D005317:Fetal Growth Retardation D005333:Fetus D005865:Gestational Age D006801:Humans D007206:Individuality D007231:Infant, Newborn D007236:Infant, Small for Gestational Age D011247:Pregnancy D011263:Pregnancy Trimester, Third D012107:Research Design D012189:Retrospective Studies D016216:Ultrasonography, Prenatal
Individualized growth assessment SGA longitudinal growth study