Fetal growth in early pregnancy and risk of delivering low birth weight infant: prospective cohort study

Abstract

Objective: To determine if first trimester fetal growth is associated with birth weight, duration of pregnancy, and the risk of delivering a small for gestational age infant.

Design: Prospective cohort study of 38 033 pregnancies between 1999 and 2003.

Setting: 15 centres representing major regions of the United States.

Participants: 976 women from the original cohort who conceived as the result of assisted reproductive technology, had a first trimester ultrasound measurement of fetal crown-rump length, and delivered live singleton infants without evidence of chromosomal or congenital abnormalities. First trimester growth was expressed as the difference between the observed and expected size of the fetus, expressed as equivalence to days of gestational age.

Main outcome measures: Birth weight, duration of pregnancy, and risk of delivering a small for gestational age infant.

Results: For each one day increase in the observed size of the fetus, birth weight increased by 28.2 (95% confidence interval 14.6 to 41.2) g. The association was substantially attenuated by adjustment for duration of pregnancy (adjusted coefficient 17.1 (6.6 to 27.5) g). Further adjustments for maternal characteristics and complications of pregnancy did not have a significant effect. The risk of delivering a small for gestational age infant decreased with increasing size in the first trimester (odds ratio for a one day increase 0.87, 0.81 to 0.94). The association was not materially affected by adjustment for maternal characteristics or complications of pregnancy.

Conclusion: Variation in birth weight may be determined, at least in part, by fetal growth in the first 12 weeks after conception through effects on timing of delivery and fetal growth velocity.

Fig 1 Birth weight as a function of ΔGA (difference between observed and expected size of fetus in first trimester of pregnancy). Mean (±SE) birth weights and fitted values from multivariable linear regression are plotted for each day of ΔGA discrepancy

Fig 2 Proportion of small for gestational age (SGA) neonates by size of ΔGA discrepancy (difference between observed and expected size of fetus in first trimester of pregnancy). Proportion (±SE) of SGA neonates and proportion of SGA neonates predicted by multivariable logistic regression are plotted by size of ΔGA discrepancy