On the issue of risk stratification of early and late forms of fetal growth restriction

Summary: It should be noted that fetal growth restriction syndrome plays a significant role in the formation of the structure of perinatal morbidity and mortality, the frequency of which, according to domestic authors, ranges from 5 to 17 %, among full-term infants – from 5% to 22 %, among preterm infants – from 18 to 24 %. About 30 million children are born with this diagnosis annually in the world. Aim: To establish the prevalence, frequency and proportion of prognostically significant predisposition factors for the development of early and late fetal growth restriction; to identify the most significant of them for the prediction of this syndrome. Materials: Two comparable groups were formed: group 1 – 159 cases (26.7 %) of early fetal growth restriction (up to 32 weeks of gestation) and group 2 – 437 cases (73.3 %) of late fetal growth restriction. The control group included 80 patients who gave birth to a full-term baby with average weight parameters in the population. The work was performed in the format of a longitudinal retrospective case-control study. The statistical analysis of the data was performed using Microsoft Office XP application packages for statistical processing of the material – Microsoft Excel (version 7.0), and the odds ratio (OR) for the occurrence of comparable values or signs was also given. Results: 654 documented forms of birth of children with FGR (2.8 %) were retrospectively analyzed, an increase in FGR cases by 1.8 times was noted. The most significant risk factors for the development of fetal growth restriction were identified, including heredity and FGR in previous pregnancy (OR – 3.11), socioeconomic factors and psycho-emotional cofounders (OR – 2.76), harmful tobacco smoking (OR – 2.47), age over 35 years (OR – 2.82), multiple pregnancy (OR – 7.83), underweight (OR – 3.69), cardiovascular disease (OR – 16.32), anaemia (OR – 2.32), placental dysfunction (OR – 3.12), umbilical cord pathology and peculiarities of its insertion (OR – 3.77). The following factors characterising a woman’s reproductive health and factors related to the course of pregnancy were associated with the risk of early FGR: sexual infantilism (OR – 2.46), uterine factor and infertility (OR – 2.19), first pregnancy in age over 35 years (OR – 2.28), spontaneous abortion and habitual miscarriage (OR – 2.11), instrumental intrauterine interventions (OR – 2.74), and previous pregnancy with FGR (OR – 3.04). An important predictor of FGR after 32 weeks of gestation (OR – 3.01) was social factors (bad habits, high levels of chronic stress and psychotraumatic factors related to martial law, internal and external migration, and family financial situation). Fetal and placental factors, including: placental dysfunction (OR – 2.0), intrauterine infection (OR – 1.62), umbilical cord pathology and features of its insertion (OR – 3.04), fetal malformations (OR – 2.20) formed risk groups for both early and late forms of FGR. Conclusions: It is undeniable that the range of factors leading to the development of fetal growth restriction is quite wide and multifaceted. Factors associated with reproductive health disorders and complicated pregnancy are important for the development of early FGR, while fetal and placental factors are equally predictive of both early and late forms of this syndrome.