First trimester growth restriction and uterine artery blood flow in the second trimester as predictors of adverse pregnancy outcome

• Published in: European journal of obstetrics & gynecology and reproductive biology 2013-05, Vol.168 (1), p.20-25
• Main Authors: Pedersen, N.G, Sperling, L, Wøjdemann, K.R, Larsen, S. Olesen, Tabor, A
• Format: Article
• Language: English
• Subjects: Adult; Case-Control Studies; CRL; Crown-Rump Length; Female; Fetal Growth Retardation - physiopathology; Gestational Age; Growth restriction; Humans; Menstrual cycle; Obstetrics and Gynecology; Placenta - blood supply; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prospective Studies; Ultrasound; Uterine Artery
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2012.12.006

Abstract Objectives To investigate if fetuses with first trimester growth restriction have poorer perfusion of the placenta compared to a control group, and to investigate whether first trimester growth restriction in combination with poor flow in the uterine arteries in the second trimester can be used to predict poor outcome. Study design Women with singleton pregnancies, where the gestational age estimated by crown-rump length (CRL) at the first trimester scan was 7 days or more smaller than the gestational age estimated by last menstrual period, and a control group of women, where the gestational age was either equal to or 1 day larger than the gestational age estimated by last menstrual period, were invited to join the study. The study entailed the routine scans; Down syndrome screening in gestational week 11–14 and an anomaly scan in gestational week 18–21. In addition to the routine scans the participants were offered a growth scan in gestational week 23–24. At the anomaly scan and growth scan, umbilical and uterine artery Doppler flows were measured. Results 182 cases and 230 controls were included in the study. The case and control groups showed no significant differences in placental blood flow characteristics at 18–21 weeks or 23–24 weeks. In our logistic regression models the only outcome that showed a significant association to the case group was birth weight below 2500 g. Having a CRL 7 days or more smaller than expected increased the risk of having a child with a birth weight below 2500 g with an odds ratio of 3.29. Conclusions We were unable to demonstrate a link between first trimester growth restriction and poor placental perfusion. The case group had increased risk of birth weight below 2500 g, but only with an odds ratio of 3. Therefore we do not recommend implementation of uterine or umbilical artery flow measurements specifically for fetuses with first trimester growth restriction.