Biparietal diameter (BPD) growth rate between the first and second trimester as a predictor of poor obstetric and neonatal outcome among the Indian population
Background: The Objective of this study was to evaluate the association of BPD at 11-14 weeks and pregnancy outcome and to determine the role of incremental BPD growth from 11-14 weeks and 17-20 weeks in pregnancy outcome.
Methods: Women (n=910) with singleton pregnancies were included in this prospective observational study after an early anomaly scan (11 to 14 weeks). Outcomes noted were the incidence of adverse events and the neonatal birth weight.
Results: Irrespective of their original BPD at 11 to 14 weeks, fetuses had acquired optimum BPD growth rate on a follow up scan at 17-20 weeks, i.e., a majority of them fell in the 10th to 90th percentile group (P value <0.001). Fetuses with BPD below the 10th percentile were small for gestational age (SGA) at birth despite an optimal growth rate. Also, a significant majority of the fetuses with BPD in the 10th to 90th percentile were Appropriate for Gestational Age (AGA) at birth.Conclusion: The BPD at 11 to 14 weeks scan predicts the incidence of SGA and AGA babies, independent of BPD growth rates between first and second trimester. The BPD growth rates were neither significantly different nor predictive of the birth weight or adverse pregnancy outcomes.
Paz I, Laor A, Gale R, Harlap S, Stevenson DK, Seidman DS. Term infants with fetal growth restriction are not at increased risk for low intelligence scores at age 17 years. J Pediatr. 2001;138(1):87-91.
Jacobsson B, Ahlin K, Francis A. Cerebral palsy and restricted growth status at birth: population-based case-control study. Br J Obstet Gynecol. 2008;115:1250-5.
Gardosi J. Intrauterine growth restriction: new standards for assessing adverse outcome. Best Pract Res Clin Obstet Gynecol. 2009;23:741-9.
Gardosi J, Figueras F, Clausson B. The customised growth potential: an international research tool to study the epidemiology of fetal growth. Paediatr Perinat Epidemiol. 2011;25(1):2-10.
Gardosi J, Clausson B, Francis A. The value of customised centiles in assessing perinatal mortality risk associated with parity and maternal size. Br J Obstet Gynaecol. 2009;116:1356-63.
Gardosi J, Francis A. Adverse pregnancy outcome and association with smallness for gestational age by customised and population based birth-weight percentiles. Am J Obstet Gynecol. 2009;201:28,e1-8.
Godfrey K, Robinson S, Barker DJ, Osmond C, Cox V. Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. Br Med J. 1996;312(7028):410-4.
Gardosi J, Mongelli M, Wilcox M, Chang A. An adjustable fetal weight standard. Ultrasound Obstet Gynecol. 1995;6:168-74.
Gordon CS, Malcolm FS, Mcnay MB, Fleming EJ. First-trimester growth and the risk of low birth weight. N Engl J Med. 1998;339:1817-22.
National Institute for Health and Clinical Excellence. NICE guideline CG6: antenatal care: routine care for the healthy pregnant woman, 2010. Available at: www.nice.org.uk/nicemedia/live/11947/40115/40115.pdf. Accessed 8 December 2010.
Pedersen NG, Wojdemann KR, Scheike T, Tabor A. Fetal growth between the first and second trimesters and the risk of adverse pregnancy outcome. Ultrasound Obstet Gynecol. 2008;32:147-54.
Vafae H, Hosseini A, Zolghadri J, Samsami A. Correlation of first trimester fetal crown-rump length and outcome of pregnancy and birth weight. Int J Gynecol Obstet. 2012 Nov;119(2):141-4.