Early rapid growth, early birth: accelerated fetal growth and spontaneous late preterm birth.

Abstract

The past two decades in the United States have seen a 24% rise in spontaneous late preterm delivery (34-36 weeks) of unknown etiology. This study tested the hypothesis that fetal growth was identical prior to spontaneous preterm (n = 221, median gestational age at birth 35.6 weeks) and term (n = 3706) birth among pregnancies followed longitudinally in Santiago, Chile. The hypothesis was not supported: Preterm-delivered fetuses were significantly larger than their term-delivered peers by mid-second trimester in estimated fetal weight, head, limb, and abdominal dimensions, and they followed different growth trajectories. Piecewise regression assessed time-specific differences in growth rates at 4-week intervals from 16 weeks. Estimated fetal weight and abdominal circumference growth rates slowed at 20 weeks among the preterm-delivered, only to match and/or exceed their term-delivered peers at 24-28 weeks. After an abrupt growth rate decline at 28 weeks, fetuses delivered preterm did so at greater population-specific sex and age-adjusted birth weight percentiles than their peers from uncomplicated pregnancies (P < 0.01). Growth rates predicted birth timing: one standard score of estimated fetal weight increased the odds ratio for late preterm birth from 2.8 prior to 23 weeks, to 3.6 (95% confidence interval, 1.82-7.11, P < 0.05) between 23 and 27 weeks. After 27 weeks, increasing size was protective (OR: 0.56, 95% confidence interval, 0.38-0.82, P = 0.003). These data document, for the first time, a distinctive fetal growth pattern across gestation preceding spontaneous late preterm birth, identify the importance of mid-gestation for alterations in fetal growth, and add perspective on human fetal biological variability.

• Authors: Michelle Lampl, Juan Pedro Kusanovic, Offer Erez, Jimmy Espinoza, Francesca Gotsch, Luis Goncalves, Sonia Hassan, Ricardo Gomez, Jyh Kae Nien, Edward A Frongillo, Roberto Romero
• Journal: American journal of human biology : the official journal of the Human Biology Council (Am J Hum Biol) Vol. 21 Issue 2 Pg. 141-50 ( 2009) ISSN: 1520-6300 [Electronic] United States
• PMID: 18988282 (Publication Type: Journal Article, Research Support, N.I.H., Intramural)

Topics

• Biometry
• Chile
• Female
• Fetal Development (physiology)
• Gestational Age
• Humans
• Infant, Newborn (growth & development)
• Infant, Premature (growth & development)
• Longitudinal Studies
• Obstetric Labor, Premature
• Phenotype
• Pregnancy
• Premature Birth
• Proportional Hazards Models
• Retrospective Studies