Comparison of three different international fetal growth restriction
definitions in Chinese population
Abstract
Background Fetal growth restriction (FGR) is defined
differently by the American College of Obstetrics and Gynecology (ACOG),
Society for Maternal-Fetal Medicine (SMFM), and the International
Society of Ultrasound in Obstetrics and Gynecology (ISUOG).
Objective The purpose of this study was to investigate the
predictive effect of three different diagnostic criteria of FGR on
small-for-gestational-age (SGA) and adverse neonatal outcome (ANO), so
as to find a better FGR-definition for Chinese population. Study
Design The clinical data of singleton pregnancy who received regular
pregnancy care and gave birth at the Department of Obstetrics and
Gynecology of Peking University First Hospital from January 1, 2021, to
June 30, 2021 were collected. FGR cases were determined according to
three different diagnostic criteria by ACOG, SMFM, or ISUOG. The primary
outcome was the prediction of SGA and a composite ANO. SGA was defined
as neonatal birth weight less than 10 th percentile.
An ANO included one of these adverse outcomes: neonatal umbilical
arterial blood pH < 7.1, 5-minute Apgar score<7,
acute respiratory distress syndrome (ARDS), intraventricular hemorrhage,
and neonatal convulsion, and transfer to the neonatal intensive care
unit (NICU). The specificity, sensitivity, negative predictive value
(NPV) and positive predictive value (PPV) of the different diagnostic
criteria for SGA and ANO were compared. The discriminatory capacities of
the three FGR-definitions were compared using the area under
receiver-operating-characteristics curves (AUC). Results A
total of 2340 cases were included in this study, and 115 (4.9%), 63
(2.7%), and 48 (2.1%) cases of FGR were diagnosed using the diagnostic
criteria issued by the SMFM, ACOG, and ISUOG respectively. There were
147 (6.28%) cases of SGA neonates. The SMFM criteria had higher
sensitivity (40.82% vs 24.49%, 20.41%) for SGA compared to the ACOG
and ISUOG criteria. On the contrary, the ISUOG criteria had a higher
specificity (99.18% vs 97.49%, 98.77%) than the SMFM and ACOG
criteria for predicting SGA. A total of 127 (5.43%) cases were
complicated with ANO. All three definitions had low sensitivity for ANO
(17.32%, 12.6%, 11.81%) and high specificity of 95.8%, 97.88% and
98.51%. The AUCs of SMFM for predicting SGA (0.692) and ANO (0.566)
were slightly higher than those of ACOG (0.616, 0.552) and ISUOG (0.598,
0.552). Conclusion The predictive value of the SMFM and ISUOG
definition for SGA and ANO was better than that of the ACOG criteria. In
Chinese population, the discriminatory capacities of SMFM FGR definition
were superior compared to the other two definitions.