Prediction of fetal growth restriction in high-risk pregnant women

Strizhakov A.N., Miryushchenko M.M., Ignatko I.V., Popova N.G., Florova V.S., Kuznetsov A.S.

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow 119991, Trubetskaya str. 8, bld. 2, Russia
Objective. To develop an individualized comprehensive examination system for pregnant women for the prediction, early diagnosis, and prevention of fetal growth restriction (FGR) based on the assessment of clinical, anamnestic, laboratory, and instrumental risk factors for reduction of perinatal morbidity and mortality.
Subjects and methods. In accordance with the goal set, the authors conducted a comprehensive prospective survey of 184 pregnant women in the first trimester of gestation, 184 newborns and also analyzed the perinatal and maternal outcomes of pregnancy. A study group consisted of 146 women whose pregnancy was complicated by placental insufficiency and resulted in the birth of living babies with FGR; a comparison group included 38 women whose pregnancy had no signs of placental insufficiency and resulted in the birth of full-term living babies. Social and marital status, place of residence; bad habits (smoking, use of alcohol and narcotics); somatic and obstetric/gynecological histories; course of the current pregnancy; characteristics of delivery; and neonatal status were assessed. The results of the first perinatal screening were assessed and the first-trimester levels of serum markers for FGR (PAPP-A, beta-hCG, IGF-1, and vitamin D) were measured in both groups. The pregnant women also underwent comprehensive dynamic ultrasound fetometric, placentographic, and Doppler studies of blood flow in the uterine arteries, umbilical artery, fetal middle cerebral artery, and fetal aorta.
Results. A regression-factor analysis was carried out to estimate the importance of each of the studied risk factors in developing FGR. After analyzing all the risk factors, the authors could identify a set of the most important factors. The most important factor proved to be IGF-1 level, and the least important one was β-hCG levels, parity, and first-trimester abortions in previous pregnancies. The group of negative factors included the levels of β-hCG, vitamin D (1,25(OH)2D), anemia, and kidney diseases. That of positive factors involved parity, threatened miscarriage, IGF-1 levels, and first-trimester abortions in previous pregnancies.
Conclusion. Thus, the comprehensive clinical, instrumental, and laboratory study of pregnant women at high risk for FGR provides an opportunity not only to timely diagnose these complications, but also to predict with a significant possibility their development just at pregravid stage, which will be able to implement a package of preconceptional corrective measures.

Keywords

fetal growth restriction
high-risk pregnant women

Supplementary Materials

  1. Table 1. Structure of significant in prediction of the fetal growth retardation syndrome of extragenital pathology in the examined women
  2. Table 2. Relative decrease (in% of normal) anthropometric parameters of the newborn in the presence of confounding facto trench during pregnancy
  3. Table 3. Average indicators of biochemical markers by groups
  4. Table 4. Degrees of circulatory disturbances in the mother-placenta-fetus system of the examined women
  5. Fig. 1. A histogram weighted regression facto molecular Browse function "fetal growth retardation syndrome"
  6. Fig. 2. Graph of conformity of calculated predictive values for the weight function of regression-factor analysis and experimental values by the criterion "fetal growth retardation syndrome"
  7. Fig. 3. Histogram of weight regression-factor function by the criterion "fetal growth retardation syndrome" on the basis of dopplerometric indications for trimester of pregnancy
  8. Fig. 4. Histogram of the weight regression-factor function by the criterion "Apgar score at the 1st and 5th minutes" on the basis of dopplerometric indications for trimester of pregnancy

References

1. Ageeva L.I., Aleksandrova G.A., Zaichenko N.M., Kirillova G.N., Leonov S.A., Mukhina T.V., Ogryzko E.V., Kharkova T.L., Chumarina V.Zh., Shubochkina E.M. Public health in Russia 2015. Moscow: Rosstat; 2015; 174 p. (in Russian)

2. Strizhakov A.N., Timokhina E.V., Ignatko I.V., Belotserkovtseva L.D. Pathophysiology of the fetus and placenta. Moscow: GEOTAR-Media; 2015; 176p. (in Russian)

3. Strizhakov A.N., Ignatko I.V., Timokhina E.V., Belotserkovtseva L.D. Fetal growth retardation syndrome. Moscow: GEOTAR-Media; 2013. 136p. (in Russian)

4. Gugushvili N.N. Clinico-pathogenetic justification of the tactics of conducting pregnancy and childbirth with delayed fetal growth. Author's abstract diss. kand. med. sciences. Moscow, 2014. 24p. (in Russian)

5. Creasy R.K., Resnik R., Iams J.D. Maternal-fetal medicine. Principles and practice. Elsevier Saunders; 2014.

6. Unterscheider J., O’Donoghue K., Malone F.D. Guidelines on fetal growth restriction: A comparison of recent national publications. Am. J. Perinatol. 2015; 32(4): 307-15.

7. Timokhina E.V. Fetal growth retardation syndrome: pathogenesis, prognosis, obstetric tactics. Author's abstract. Diss. Doctor Med. Sciences. Moscow; 2012. 50p. (in Russian)

8. Strizhakov A.N., Ignatko I.V., Kardanova M.A. Critical condition of the fetus: definition, diagnostic criteria, obstetric tactics, perinatal outcomes. Voprosy ginekologii, akusherstva i perinatologii. 2015; 14(4): 5-14. (in Russian)

9. Makatsariya A.D., Chervenak F.A., Bitsadze V.O., eds. Pregnancy high risk. Moscow: MIA; 2015. (in Russian)

10. Netrebenko O.K. Metabolic programming in the antenatal period. Voprosy ginekologii, akusherstva i perinatologii. 2012; 11(6): 58-66. (in Russian)

11. Volodin N.N., Degtyarev D.N., Shabalov N.P., eds. Neonatology. National guideline. Moscow: GEOTAR-Media, 2009; 848p. (in Russian)

12. American College of Obstetricians and Gynecologists. Practice bulletin no. 134: fetal growth restriction. Obstet. Gynecol. 2013; 121(5): 1122-33.

13. Barker D.J. In utero programming of chronic disease. Clin. Sci.(London). 1998: 95(2): 115-28.

14. Breathnach F.M., Malone F.D., Lambert-Messerlian G., Cuckle H.S., Porter T.F., Nyberg D.A. et al. First- and second-trimester screening: detection of aneuploidies other than Down syndrome. Obstet. Gynecol. 2007; 110(3):651-7.

15. Goetzinger K.R., Singla A., Gerkowicz S., Dicke J.M., Gray D.L., Odibo A.O. The efficiency of first-trimester serum analytes and maternal characteristics in predicting fetal growth disorders. Am. J. Obstet. Gynecol. 2009; 201(4):412. e1-6.

16. Kagan K.O., Wright D., Spencer K., Molina F.S., Nicolaides K.H. First-trimester screening for trisomy 21 by free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A: impact of maternal and pregnancy characteristics. Ultrasound Obstet. Gynecol. 2008; 31(5):493-502.

17. Meloni P., D'Angeli I., Piazze J., Cerekya A., Simari T., Pala A. et al. First trimester PAPP-A levels associated with early prediction of pregnancy induced hypertension. Hypertens. Pregnancy. 2009; 28(4): 361-8.

18. Zhong Y., Tuuli M., Odibo A.O. First-trimester assessment of placenta function and the prediction of preeclampsia and intrauterine growth restriction. Prenat. Diagn. 2010; 30(4): 293-308.

19. Maltseva L.I., Polukayeva A.S., Garifullova Yu.V. The role of vitamin D in maintaining the health of women's reproductive potential. Prakticheskaya meditsina. 2015; 1: 26-31. (in Russian)

20. Kovacs C.S. Vitamin D in pregnancy and lactation: maternal, fetal and neonatal outcomes from human and animal studies. Am. J. Clin. Nutr. 2008; 88(2):520S-8S.

21. Albu A.R., Anca A.F., Horhoianu V.V., Horhoianu I.A. Predictive factors for intrauterine growth restriction. J. Med. Life. 2014; 7(2): 165-71.

Received 12.12.2016

Accepted 23.12.2016

About the Authors

Strizhakov Alexander Nikolayevich, Academician of the Russian Academy of Sciences, Professor, MD, Head of the Department of Obstetrics, Gynecology and Perinatology
of the Faculty of Physiotherapy, I.M. Sechenov First Moscow State Medical University.
119991, Russia, Moscow, Trubetskaya str. 8, bld. 2. Tel.: +74997824513. E-mail: kafedra-agp@mail.ru
Miryushchenko Maria Mikhailovna, Assistant of the Department of Obstetrics, Gynecology and Perinatology of the Medical Faculty of the State Pedagogical University,
I.M. Sechenov First Moscow State Medical University. 119991, Russia, Moscow, Trubetskaya str. 8, bld. 2. Tel.: +74997824513. E-mail: m_edelveis@mail.ru
Ignatko Irina Vladimirovna, Corresponding Member of the Russian Academy of Sciences, MD, Professor of the Department of Obstetrics, Gynecology and Perinatology
of the Faculty of Physiology, I.M. Sechenov First Moscow State Medical University.
119991, Russia, Moscow, Trubetskaya str. 8, bld. 2. Tel.: +74997824513, +79104617302. E-mail: iradocent@mail.ru
Popova Natalia Gennadievna, doctor of the maternity hospital at the city’s multidisciplinary clinical hospital named after S.S. Yudin, Moscow.
Tel.: +74997824513. E-mail: kafedra-agp@mail.ru
Florova Violetta Sergeevna, full-time post-graduate student of the Department of Obstetrics, Gynecology and Perinatology of the Faculty of Physiotherapy, I.M. Sechenov
First Moscow State Medical University. 119991, Russia, Moscow, Trubetskaya str. 8, bld. 2. Tel.: +74997824513. E-mail: kafedra-agp@mail.ru
Kuznetsov Anton Sergeevich, full-time post-graduate student of the Department of Obstetrics, Gynecology and Perinatology of the Faculty of Medicine
of the State Pedagogical University, I.M. Sechenov First Moscow State Medical University.
119991, Russia, Moscow, Trubetskaya str. 8, bld. 2. Tel.: +74997824513. E-mail: kafedra-agp@mail.ru

For citations: Strizhakov A.N., Miryushchenko M.M., Ignatko I.V., Popova N.G., Florova V.S., Kuznetsov A.S. Prediction of fetal growth restriction in high-risk pregnant women.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (7): 34-44. (in Russian)
http://dx.doi.org/10.18565/aig.2017.7.34-44

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.