Abstract
Background Fetal growth restriction (FGR) is defined
differently by the American College of Obstetrics and Gynecology (ACOG),
Society for Maternal-Fetal Medicine (SMFM), and the
International
Society of Ultrasound in Obstetrics and Gynecology (ISUOG).
Objective The purpose of this study was to investigate the
predictive effect of three different
diagnostic criteria of FGR on
small-for-gestational-age (SGA) and adverse neonatal outcome (ANO), so
as to find a better FGR-definition for Chinese population.
Study Design The clinical data of singleton pregnancy who
received regular pregnancy care and gave birth at the Department of
Obstetrics and Gynecology of Peking University First Hospital from
January 1, 2021, to June 30, 2021 were collected. FGR cases were
determined according to three different diagnostic criteria by ACOG,
SMFM, or ISUOG. The primary outcome was the prediction of SGA and a
composite ANO. SGA was defined as
neonatal
birth weight less than 10th percentile.
An
ANO included one of these adverse outcomes: neonatal umbilical arterial
blood pH < 7.1, 5-minute Apgar score<7, acute
respiratory distress syndrome (ARDS), intraventricular hemorrhage, and
neonatal convulsion, and transfer to the neonatal intensive care unit
(NICU).
The
specificity, sensitivity, negative predictive value (NPV) and positive
predictive value (PPV) of the different diagnostic criteria for SGA and
ANO were compared.
The
discriminatory
capacities of the three FGR-definitions were compared using the area
under receiver-operating-characteristics curves (AUC).
ResultsA
total of 2340 cases were included in this study, and 115 (4.9%), 63
(2.7%), and 48 (2.1%) cases of FGR were diagnosed using the diagnostic
criteria issued by the SMFM, ACOG, and ISUOG respectively.
There
were 147 (6.28%) cases of SGA
neonates.
The
SMFM criteria had higher sensitivity (40.82% vs 24.49%, 20.41%) for
SGA compared to the ACOG and ISUOG criteria. On the contrary, the ISUOG
criteria had a higher specificity (99.18% vs 97.49%, 98.77%) than the
SMFM and ACOG criteria for predicting SGA. A total of 127 (5.43%) cases
were complicated with
ANO.
All three definitions had low sensitivity for ANO (17.32%, 12.6%,
11.81%) and high specificity of 95.8%, 97.88% and 98.51%. The AUCs
of SMFM for predicting SGA (0.692) and ANO (0.566) were slightly higher
than those of ACOG (0.616, 0.552) and ISUOG (0.598, 0.552).
ConclusionThe
predictive value of the SMFM and ISUOG definition for SGA and ANO was
better than that of the ACOG criteria. In Chinese population,
the
discriminatory
capacities of SMFM FGR definition were superior compared to the other
two definitions.
Key words : FGR; diagnostic criteria; SGA, ANO, Chinese
population