90 - Antenatal Doppler Velocimetry Utilization for Predicting Outcomes in Small for Gestational Age Newborns

Poster Number: 90
Publication Number: 90.362

Background: Fetal growth restriction (FGR) is a consequence of chronic fetal hypoxia secondary to uteroplacental hypoperfusion. As a leading cause of perinatal morbidity, it is crucial to monitor pregnancies impacted by FGR via antenatal ultrasound with Doppler velocimetry. It is known that abnormal umbilical artery Doppler (UAD) studies implicate poor neonatal outcomes, but their ability to predict specific morbidity has not yet been explored

Objective: To identify postnatal complications in small-for-gestational-age (SGA) neonates that can be predicted via antenatal ultrasound studies in FGR fetuses

Design/Methods: A retrospective chart review of SGA neonates was performed with review of corresponding antenatal sonograms. Pregnancies affected by known chromosomal abnormality were excluded. Group comparisons were performed using a student t-test for continuous variables and a chi-square test for categorical variables with a significance threshold of 0.05

Results: Antenatal FGR was diagnosed in 82 SGA neonates whose estimated fetal weight or abdominal circumference were < 10th% of gestational age (GA). 45.1% of neonates were diagnosed as FGR at < 32 wks GA. Maternal chart review showed varied racial distribution and mean maternal age of 32.3 (SD = 6.0). Median maternal BMI was 27.2 (25.4-30.5).37.8% of mothers had hypertensive disorders and 16.2% had gestational diabetes. 41.7% of neonates had abnormal pulsatility index (PI) on middle cerebral artery (MCA) doppler (n=24, p=0.07). 12.5% of neonates had reversal of end diastolic flow (EDF) on UAD (n=3, p=0.55), and 33.3% had absent EDF (n=8, p=0.08). 78.4% were delivered via Cesarean section CS (n=29, p=0.01). 75% of neonates experienced feeding problems (n=27). Neonates without feeding problems had no MCA PI abnormalities or changes in UAD EDF

Conclusion(s): Our preliminary data showed that neonates diagnosed with FGR before 32 wks GA had higher incidence of CS delivery than those diagnosed with FGR at or after 32 wks. Additionally, these neonates experienced feeding difficulties. While the association between MCA Doppler and feeding intolerance trend did not reach statistical significance (p=0.07), it is still considered clinically important due to the high percentage of feeding issues observed in the sample.This could be due to the small size of the study. Future investigative efforts are warranted to determine the reliability of our results in a higher powered database. Such research could inspire the development of antenatal sonographic markers for postnatal complications, optimizing informed care and prenatal counseling of pregnancies affected by FGR.