%0 Journal Article
%T Intrauterine Growth Restriction: Effects of Physiological Fetal Growth Determinants on Diagnosis
%A Kjell Haram
%A Eirik S£¿fteland
%A Radek Bukowski
%J Obstetrics and Gynecology International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/708126
%X The growth of the fetus, which is strongly associated with the outcome of pregnancy, reflects interplay of several physiological and pathological factors. The assessment of fetal growth is based on comparison of birthweight (BW) or estimated fetal weight (EFW) to standards which define reference ranges at a spectrum of gestational ages. Most birthweight standards do not take into account effects of physiological determinants of fetal growth. Additionally, gestational age in many standards is based on the menstrual history and is often inaccurate. Fetal growth norms should be based on an early ultrasound estimate of gestational age. Customized standards, which have included only ultrasound-dated pregnancies, seem to be superior to population-based birthweight norms in predicting perinatal mortality and morbidity. Adjustment for individual variation in customized growth curves reduces false-positive diagnosis of IUGR and may lead to a very significant reduction in intervention for suspected IUGR. Customized growth potential identifies better the risk for adverse outcome than the currently used national standards, but customized charts may fail in detecting growth-restricted stillbirth. An individual¡¯s birthweight is the sum of physiological and pathological influences operating during pregnancy. Growth potential norms are a better discriminator of aberrations of fetal growth than population, ultrasound, and customized norms. 1. Introduction The assessment of fetal growth is based on comparison of birthweight (BW) or estimated fetal weight (EFW) to standards which define reference ranges at a spectrum of gestational ages [1¨C3]. EFW and BW are indirect measures of the outcome of primary interest, the intrauterine fetal growth. The growth of the fetus, which is strongly associated with the outcome of pregnancy, reflects interplay of several physiological and pathological factors [4¨C6]. The aim of this study was to review different birthweight standards and evaluate effects of physiological determinants of fetal growth on the ability of the different standards for BW, EFW, and customized growth charts to identify adverse outcomes of pregnancy. 2. Study Design A non-systematic search in the PubMed was undertaken using terms ¡°birthweight¡± combined with ¡°gestational age,¡± ¡°menstrual dating,¡± ¡°ultrasound dating,¡± ¡°estimated fetal weight,¡± ¡°customized growth charts,¡± ¡°malformation,¡± ¡°stillbirth,¡± ¡°family influence,¡± and ¡°individualized BW ratio,¡± respectively. We have focused on studies that proposed fetal growth standards which took into account effects of
%U http://www.hindawi.com/journals/ogi/2013/708126/