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. 2016 Jul 15;184(2):110-9.
doi: 10.1093/aje/kwv345. Epub 2016 Jul 1.

Fetal Growth and the Risk of Spontaneous Preterm Birth in a Prospective Cohort Study of Nulliparous Women

Uttara Partap, Ulla Sovio, Gordon C S Smith

Fetal Growth and the Risk of Spontaneous Preterm Birth in a Prospective Cohort Study of Nulliparous Women

Uttara Partap et al. Am J Epidemiol. .

Abstract

Previous studies have suggested an association between fetal growth restriction and the risk of spontaneous preterm birth (sPTB). However, addressing this association is methodologically challenging. We conducted a prospective cohort study of nulliparous women with a singleton pregnancy in Cambridge, United Kingdom (2008-2012). Ultrasonic fetal biometry was performed at 20 weeks of gestation as per routine clinical care. Participants also had blinded research ultrasonography performed at approximately 28 weeks. Biometric measurements were expressed as gestational-age-adjusted z scores. Fetal growth velocity was quantified by change in z score between 20 weeks and 28 weeks. Risk of sPTB, defined as delivery at ≥28 weeks and <37 weeks associated with labor in the absence of induction, was analyzed using cause-specific Cox regression. Of 3,892 women, 98 (2.5%) had sPTB. When compared with the other decile groups, the lowest decile of growth velocity of the fetal femur between 20 and 28 weeks was associated with increased risk of sPTB (hazard ratio = 2.37, 95% confidence interval: 1.43, 3.93; P < 0.001). Adjustment for maternal characteristics had no material effect (hazard ratio = 2.50, 95% confidence interval: 1.50, 4.14; P < 0.001). There were no significant associations between other fetal measurements and risk of sPTB. To conclude, slow growth velocity of the fetal femur is associated with an increased risk of sPTB.

Keywords: fetal biometry; fetal growth; growth velocity; preterm birth; spontaneous preterm birth.

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Figures

Figure 1.
Figure 1.
Cumulative incidence (number of births/100 women) of spontaneous preterm birth between 28 + 0/7 and 36 + 6/7 weeks of gestation (see “Statistical analysis” section in text) in the Pregnancy Outcome Prediction (POP) Study, Cambridge, United Kingdom, 2008–2012. Fetuses in the lowest decile of femur length growth velocity between 20 and 28 weeks of gestation (solid line) were compared with all other fetuses (dashed line) using the competing-risks method (P = 0.001).
See this image and copyright information in PMC

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