Antenatal identification of early- and late-onset fetal growth restriction and the possible impact of the introduction of cerebroplacental ratio: Effect on perinatal and childhood outcome

PMCID: PMC12176146

PMID: 40531933

DOI: 10.1371/journal.pone.0325906

Journal: PloS one

Publication Date: 2025-6-18

Authors: Hertting E, Herling L, Lindqvist PG, Wiberg-Itzel E

Key Points

• Antenatal identification of early-onset FGR reduces stillbirth risk but increases risks of severe newborn and childhood outcomes
• Early-onset FGR identification associated with 81% increased risk of severe adverse outcomes (aOR 1.81, 95% CI 1.25-2.61)
• Timing of FGR identification critically influences potential clinical interventions and long-term prognostic understanding

Summary

This register-based cohort study investigated the impact of antenatal identification of small for gestational age (SGA) fetuses on perinatal and childhood outcomes, distinguishing between early-onset and late-onset fetal growth restriction (FGR). Analyzing 5,499 SGA newborns in Stockholm, the research revealed nuanced outcomes based on the timing of FGR identification.

Early-onset FGR identification demonstrated a complex clinical profile: while associated with a decreased risk of stillbirth (adjusted OR 0.47, 95% CI 0.23-0.96), it was simultaneously linked to increased risks of severe newborn distress (aOR 2.80, 95% CI 1.79-4.39) and severe childhood outcomes (aOR 3.00, 95% CI 1.51-5.94). Late-onset FGR identification showed less pronounced effects, with only a marginally increased risk of severe childhood outcome (aOR 1.91, 95% CI 1.04-3.52).

The study highlights the critical importance of understanding the temporal dynamics of fetal growth restriction and its potential long-term implications. While early detection can mitigate some risks like stillbirth, it may also reveal underlying complexities that contribute to increased neonatal and childhood morbidity.