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Publication Detail
Characteristics associated with antenatally unidentified small-for-gestational-age fetuses: prospective cohort study nested within the DESiGN randomized control trial.
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Journal Article
  • Authors:
    Relph S, Vieira MC, Copas A, Alagna A, Page L, Winsloe C, Shennan A, Briley A, Johnson M, Lees C, Lawlor DA, Sandall J, Khalil A, Pasupathy D, DESiGN Trial Team and DESiGN Collaborative Group
  • Publication date:
  • Journal:
    Ultrasound Obstet Gynecol
  • Status:
    Published online
  • Country:
  • Language:
OBJECTIVE: To identify the clinical characteristics and patterns of ultrasound use amongst pregnancies with antenatally unidentified SGA, compared to those in which it is identified, to understand how to better design interventions that improve antenatal SGA identification. METHODS: A prospective cohort study of singleton, non-anomalous, small for gestational age (SGA, birthweight<10th centile) babies born after 24+0 gestational weeks, from 13 UK sites, collected for the baseline period and control arm of the DESiGN trial. We define pregnancies with antenatally unidentified SGA where there was no scan or a final scan with estimated fetal weight, EFW, at 10th centile or above; and as identified SGA if EFW was below 10th centile at last scan. Maternal and fetal sociodemographic and clinical characteristics were studied for associations with unidentified SGA using unadjusted and adjusted logistic regression models. Ultrasound parameters (gestational age at first growth scan, ultrasound frequency, duration between the last scan and the birth, absolute centile difference between the last scan and the birth) were described and associations with missed SGA were also studied by unadjusted and adjusted logistic regression but stratified by presence of indications for serial ultrasound. RESULTS: Of the 15,784 SGA babies included, SGA was not identified antenatally in 78.7%. Of pregnancies with unidentified SGA, 47.1% had no recorded growth scan. Amongst 9,410 pregnancies with complete data on key maternal co-morbidities and antenatal complications, the risk of unidentified SGA was lower for women with any indication for serial scans (aOR 0.56, 95% CI: 0.49-0.64), Asian ethnicity (aOR 0.80 compared to white, 95% CI: 0.69-0.93) and non-cephalic presentation (aOR 0.58, 95% CI: 0.46-0.73). The risk of unidentified SGA was highest among women with BMI 25.0-29.9 kg/m2 (aOR 1.15 compared to 18.5-24.9 kg/m2 , 95% CI: 1.01-1.32) and lowest in those with underweight BMI (aOR 0.61, 95% CI: 0.48-0.76). Compared to women with identified SGA, those with unidentified SGA had fetuses of higher SGA birthweight centile (adjusted mean difference 1.21, 95% CI: 1.18-1.23). Duration between the last scan and birth increased with advancing gestation in pregnancies with unidentified SGA. SGA babies born within a week of the last growth scan had a mean EFW: birthweight centile difference of +19.5 (SD: 13.8) for unidentified SGA babies and +0.2 (SD: 3.3) for identified SGA babies (adjusted difference 19.0, CI: 17.8-20.1). CONCLUSIONS: Unidentified SGA was more common amongst women without indications for serial ultrasound, cephalic presentation, BMI 25.0-29.9 kg/m2 and less severe SGA. Ultrasound EFW was overestimated in women with unidentified SGA. This demonstrates the importance of improving the accuracy of SGA screening strategies in low-risk populations, and continuing ultrasound scans for term pregnancies. This article is protected by copyright. All rights reserved.
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