PREMATURE BABIES WITH FETAL GROWTH RESTRICTION: A MODERN VIEW OF THE PROBLEM
Main Article Content
Abstract
Fetal growth restriction (FGR) is an interdisciplinary problem attracting the attention of obstetricians, neonatologists, and pediatricians. Priority research areas include improving diagnostic efficiency, optimizing perinatal monitoring, and choosing the optimal timing of delivery, which determine the nature of potential adverse effects both in newborns and later in life.
The aim of the research – to analyze and summarize current data from Russian and international literature on intrauterine growth restriction in preterm infants, including terminology, epidemiology, etiopathogenesis, perinatal outcomes, and neonatal morbidity patterns in various clinical forms of FGR.
Material and methods. Analyzed scientific publications in Russian and international peer-reviewed journals, as well as guidelines from international expert organizations (WHO, FIGO) and consensus documents (Delphi consensus, COSNEON). The literature search was conducted using the following keywords: intrauterine growth restriction, fetal growth restriction, small-for-gestational age, premature infants, neonatal morbidity, perinatal outcomes.
Results. An analysis of neonatal morbidity in early-onset IUGR demonstrates a high incidence of respiratory distress syndrome (up to 36%), bronchopulmonary dysplasia (up to 43%), necrotizing enterocolitis (up to 11-22%), retinopathy of prematurity (up to 29%), and neonatal sepsis (up to 64%). IUGR was found to be an independent risk factor for psychomotor developmental disorders in early-onset premature infants.
Conclusion. The health status and range of diseases in premature infants with FGR depend on a wide range of causes and risk factors. Given the inconsistency of the obtained results, further study and development of scientifically based approaches to predicting and preventing the most significant pathology associated with fetal growth restriction in preterm infants is relevant.
Keywords
Article Details
Information about financing and conflict of interests
The author declares that there are no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
How to Cite
References
1. Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, et al. Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017. BJOG. 2025; 132(Suppl 8): S48-S59. doi: 10.1111/1471-0528.17518
2. Ashorn P, Ashorn U, Muthiani Y, Aboubaker S, Askari S, Bahl R, et al. Small vulnerable newborns-big potential for impact. Lancet. 2023; 401(10389): 1692-1706. doi: 10.1016/S0140-6736(23)00354-9
3. Lawn JE, Ohuma EO, Bradley E, Idueta LS, Hazel E, Okwaraji YB, et al. Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve counting. Lancet. 2023; 401(10389): 1707-1719. doi: 10.1016/S0140-6736(23)00522-6
4. Gette F, Aziz Ali S., Ho MSP, Richter LL, Chan ES, Yang CL, et al. Long-term health outcomes of preterm birth: a narrative review. Front Pediatr. 2025; 13: 1565897. doi: 10.3389/fped.2025.1565897
5. Tsikouras P, Antsaklis P, Nikolettos K, Kotanidou S, Kritsotaki N, Bothou A, et al. Diagnosis, Prevention, and Management of Fetal Growth Restriction (FGR). J Pers Med. 2024; 14(7): 698. doi: 10.3390/jpm14070698
6. Chew LC, Osuchukwu OO, Reed DJ, Verma RP. Fetal Growth Restriction. 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
7. Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016; 48(3): 333-339. doi: 10.1002/uog.15884
8. Damhuis SE, Ganzevoort W, Gordijn SJ. Abnormal Fetal Growth: Small for Gestational Age, Fetal Growth Restriction, Large for Gestational Age: Definitions and Epidemiology. Obstet Gynecol Clin North Am. 2021; 48(2): 267-279. doi: 10.1016/j.ogc.2021.02.002
9. Beune IM, Bloomfield FH, Ganzevoort W, Embleton ND, Rozance PJ, van Wassenaer-Leemhuis AG, et al. Consensus Based Definition of Growth Restriction in the Newborn. J Pediatr. 2018; 196: 71-76.e1. doi: 10.1016/j.jpeds.2017.12.059
10. Lawn JE, Ohuma EO, Bradley E, Idueta LS, Hazel E, Okwaraji YB, et al. Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve counting. Lancet. 2023; 401(10389): 1707-1719. doi: 10.1016/S0140-6736(23)00522-6
11. Colella M, Frérot A, Novais ARB, Baud O. Neonatal and Long-Term Consequences of Fetal Growth Restriction. Curr Pediatr Rev. 2018; 14(4): 212-218. doi: 10.2174/1573396314666180712114531
12. Sevostyanova OYu, Chumarnaya TV, Belomestnov SR, Ksenofontova OL. The incidence of fetal growth retardation: trends over the decade. Russian Pediatric Journal. 2024; 27(4): 241-248. Russian (Севостьянова О.Ю., Чумарная Т.В., Беломестнов С.Р., Ксенофонтова О.Л. Задержка внутриутробного роста и развития плода: тенденции десятилетия //Российский педиатрический журнал. 2024. Т. 27, № 4. С. 241-248.) doi: 10.46563/1560-9561-2024-27-4-241-248
13. Melamed N, Baschat A, Yinon Y, Athanasiadis A, Mecacci F, Figueras F, et al. FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction. Int J Gynaecol Obstet. 2021; 152(Suppl 1): 3-57. doi: 10.1002/ijgo.13522
14. Beune IM, Damhuis SE, Ganzevoort W, Hutchinson JC, Khong TY, Mooney EE, et al. Consensus Definition of Fetal Growth Restriction in Intrauterine Fetal Death: A Delphi Procedure. Arch Pathol Lab Med. 2021; 145(4): 428-436. doi: 10.5858/arpa.2020-0027-OA
15. Giouleka S, Tsakiridis I, Mamopoulos A, Kalogiannidis I, Athanasiadis A, Dagklis T. Fetal Growth Restriction: A Comprehensive Review of Major Guidelines. Obstet Gynecol Surv. 2023; 78(11): 690-708. doi: 10.1097/OGX.0000000000001203
16. Natarajan V, Singh P, Vigneshwar NKV, Anthony ML, Rao S, Chacham S, et al. Maternal and Placental Risk Factors for Small Gestational Age and Fetal Malnutrition. Curr Pediatr Rev. 2023; 19(2): 187-196. doi: 10.2174/1573396318666220705154424
17. Tsikouras P, Antsaklis P, Nikolettos K, Kotanidou S, Kritsotaki N, Bothou A, et al. Diagnosis, Prevention, and Management of Fetal Growth Restriction (FGR). J Pers Med. 2024; 14(7): 698. doi: 10.3390/jpm14070698
18. Pels A, Beune IM, van Wassenaer-Leemhuis AG, Limpens J, Ganzevoort W. Early-onset fetal growth restriction: A systematic review on mortality and morbidity. Acta Obstet Gynecol Scand. 2020; 99(2): 153-166. doi: 10.1111/aogs.13702
19. Mylrea-Foley B, Thornton JG, Mullins E, Marlow N, Hecher K, Ammari C, et al. Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol. BMJ Open. 2022; 12(4): e055543. doi: 10.1136/bmjopen-2021-055543
20. Sandovici I, Knee O, Lopez-Tello J, Shreeve N, Fowden AL, Sferruzzi-Perri AN, Constância M. A genetically small fetus impairs placental adaptations near term. Dis Model Mech. 2024; 17(8): dmm050719. doi: 10.1242/dmm.050719
21. Hales CN, Barker DJ. The thrifty phenotype hypothesis. Br Med Bull. 2001; 60: 5-20. doi: 10.1093/bmb/60.1.5
22. Barker DJ, Hales CN, Fall CH, Osmond C, Phipps K, Clark PM. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia. 1993; 36(1): 62-67. doi: 10.1007/BF00399095
23. Bujorescu DL, Ratiu A, Citu C, Gorun F, Gorun OM, Crisan DC, et al. Appropriate delivery timing in fetuses with fetal growth restriction to reduce neonatal complications: A case-control study in Romania. J Pers Med. 2023; 13(4): 645. doi: 10.3390/jpm13040645
24. Shcherbakova E.A., Baranov A.N., Istomina N.G. Outcomes of early- and late-onset fetal growth restriction according to diagnostic criteria. Gynecology, Obstetrics and Perinatology. 2024; 23(3): 23-29. Russian (Щербакова Е.А., Баранов А.Н., Истомина Н.Г. Исходы ранней и поздней форм задержки роста плода в зависимости от критериев диагностики //Вопросы гинекологии, акушерства и перинатологии. 2024. Т. 23, № 3. С. 23-29.) doi: 10.20953/1726-1678-2024-3-23-29
25. Khalil A, Beune I, Hecher K, Wynia K, Ganzevoort W, Reed K, et al. Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure. Ultrasound Obstet Gynecol. 2019; 53(1): 47-54. doi: 10.1002/uog.19013
26. Unterscheider J, O'Donoghue K, Daly S, Geary MP, Kennelly MM, McAuliffe FM, et al. Fetal growth restriction and the risk of perinatal mortality-case studies from the multicentre PORTO study. BMC Pregnancy Childbirth. 2014; 14: 63. doi: 10.1186/1471-2393-14-63
27. Damhuis SE, Bloomfield FH, Khalil A, Daly M, Ganzevoort W, Gordijn SJ. A Core Outcome Set and minimum reporting set for intervention studies in growth restriction in the NEwbOrN: the COSNEON study. Pediatr Res. 2021; 89(6): 1380-1385. doi: 10.1038/s41390-020-01119-5
28. Selvaratnam RJ, Wallace EM, Treleaven S, Hooper SB, Davis PG, Davey MA. Does detection of fetal growth restriction improve neonatal outcomes? J Paediatr Child Health. 2021; 57(5): 677-683. doi: 10.1111/jpc.15310
29. Packer CH, Pilliod RA, Caughey AB, Sparks TN. Optimal timing of delivery for growth restricted fetuses with gastroschisis: A decision analysis. Prenat Diagn. 2023; 43(12): 1506-1513. doi: 10.1002/pd.6452
30. Lingam I, Okell J, Maksym K, Spencer R, Peebles D, Buquis G, et al. Neonatal outcomes following early fetal growth restriction: a subgroup analysis of the EVERREST study. Arch Dis Child Fetal Neonatal Ed. 2023; 108(6): 599-606. doi: 10.1136/archdischild-2022-325285
31. Lees C, Marlow N, Arabin B, Bilardo CM, Brezinka C, Derks JB, et al. Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol. 2013; 42(4): 400-408. doi: 10.1002/uog.13190
32. McGillick EV, Orgeig S, Morrison JL. Structural and molecular regulation of lung maturation by intratracheal vascular endothelial growth factor administration in the normally grown and placentally restricted fetus. J Physiol. 2016; 594(5): 1399-1420. doi: 10.1113/JP271113
33. Pascal A, de Bruyn N, Naulaers G, Ortibus E, Hanssen B, Oostra A, et al. The Impact of Intraventricular Hemorrhage and Periventricular Leukomalacia on Mortality and Neurodevelopmental Outcome in Very Preterm and Very Low Birthweight Infants: A Prospective Population-based Cohort Study. J Pediatr. 2023; 262: 113600. doi: 10.1016/j.jpeds.2023.113600
34. Jensen A, Rochow N, Voigt M, Neuhäuser G. Differential effects of growth restriction and immaturity on predicted psychomotor development at 4 years of age in preterm infants. AJOG Glob Rep. 2024; 4(1): 100305. doi: 10.1016/j.xagr.2023.100305