Modern Pediatrics. Ukraine. (2024). 2(138): 91-97. doi: 10.15574/SP.2024.138.91
Yarotska Yu. O.¹, Govsіeіev D. О.^1,2
1Perinatal Center of Kyiv, Ukraine
²Bogomolets National Medical University, Kyiv, Ukraine

For citation: Yarotska YuO, Govsіeіev DО. (2024). The influence of risk factors on the formation of insufficient growth of the fetus. Modern Pediatrics. Ukraine. 2(138): 91-97. doi: 10.15574/SP.2024.138.91.
Article received: Dec 10, 2023. Accepted for publication: Mar 12, 2024.

Fetal growth retardation is defined as the condition of a fetus whose weight is less than 10% of the gestational weight age, that is, the fetus does not reach its genetic growth potential.
Aim – to determine the risk factors contributing to the formation of fetal growth retardation.
Materials and methods. A retrospective study of medical documentation of 110 patients (main group) with a confirmed fetal growth restriction and 70 pregnant women of the control group, searching risk factors for fetal growth restriction.
Results. The frequency of abnormalities of the umbilical cord and placenta was 24.5% in the main group against 4% in the control group. Extragenital diseases occurred in 74.5% versus 20% in the control group. In addition, uterine malformations (6.3% in the main and 2% in the control groups), low weight before pregnancy 41.8% in the main and 20% in the control group. Heavy bleeding in the I and II trimesters of pregnancy – 10% in the main group versus 2% in the control group, abnormal biochemical markers of I and II screening – 56.3% in the main group versus 30% in the control group.
Conclusions. Insufficient growth of the fetus is a multifactorial pathology, among the leading pathogenetic factors of extragenital diseases, uterine malformations, additional reproductive technologies, low maternal weight before pregnancy. Except moreover, risk factors for fetal growth retardation are previous births a child with a low weight, the interval between pregnancies less than 18 months  and the mother's age is over 35 years old. 13.6% of pregnant women with insufficient fetal growth had more than 3 factors risk (in the control group – 1.4%), however, more than a third of patients who had such a pregnancy complication (35.4%) had none of the listed risk factors, which prompts further research into pathogenesis.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the children's parents was obtained for the research.
The authors declare no conflict of interest.
Keywords: risk factors, fetal development delay, pathophysiological mechanism occurrence of insufficient growth of the fetus, trophoblast invasion, spiral arterioles, uterine placental blood flow.

REFERENCES

1. ACOG. (2021). Fetal Growth Restriction: ACOG Practice Bulletin, Number 227. Practice. Guideline. Obstet Gynecol. 137(2): 16-28. https://doi.org/10.1097/AOG.0000000000004251; PMid:33481528

2. Chauhan S, Beydoun H, Chang E et al. (2013). Prenatal detection of fetal growth restriction in newborns classified as small for gestational age: correlates and risk of neonatal morbidity. American Journal of Perinatology. 31(3): 187-194. https://doi.org/10.1055/s-0033-1343771; PMid:23592315

3. Chhabra S, Chopra S. (2015). Mid pregnancy fetal growth restriction and maternal anaemia a prospective study. Journal of Nutritional Disorders&Therapy. 06(2). https://doi.org/10.4172/2161-0509.1000187

4. Cohen Y, Gutvirtz G, Avnon T, Sheiner E. (2024). Chronic hypertension in pregnancy and Placenta-Mediated complications regardless of preeclampsia. Journal of Clinical Medicine. 13(4): 1111. https://doi.org/10.3390/jcm13041111; PMid:38398426 PMCid:PMC10889586

5. Declercq E, Luke B, Belanoff C et al. (2015). Perinatal outcomes associated with assisted reproductive technology: the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART). Fertility and Sterility. 103(4): 888-895. https://doi.org/10.1016/j.fertnstert.2014.12.119; PMid:25660721 PMCid:PMC4385441

6. Kozinszky Z, Surányi A. (2023). The High-Risk profile of selective growth restriction in monochorionic twin pregnancies. Medicina. 59(4): 648. https://doi.org/10.3390/medicina59040648; PMid:37109605 PMCid:PMC10141888

7. Krasovska OV, Lakatosh VP, Slobodyanyk OY, Guzhevska IV, Tkalich VO. (2019). Features of some ultrasonic indicators in pregnancy with single umbilical artery. Health of woman 5(141): 54-58. http://nbuv.gov.ua/UJRN/Zdzh_2019_5_14. https://doi.org/10.15574/HW.2019.141.54

8. Lee A, Kozuki N, Cousens S et al.(2017). Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21 ststandard: analysis of CHERG datasets. The BMJ. 17; 358: j3677. https://doi.org/10.1136/bmj.j3677; PMid:28819030 PMCid:PMC5558898

9. Lees C, Stampalija T, Baschat A et al. (2020). ISUOG Practice Guidelines: diagnosis and management of small‐for‐gestational‐age fetus and fetal growth restriction. Ultrasound in Obstetrics & Gynecology. 56(2): 298-312. https://doi.org/10.1002/uog.22134; PMid:32738107

10. Leush S, Ter-Tumasova A. (2024). Vplyv vzhyvannia atsetylsalitsylovoi kysloty na adaptatsiiu ploda pry platsentarnii dysfunktsii. Reproduktyvne zdorov'ia zhinky. (1): 42-47. https://doi.org/10.30841/2708-8731.1.2024.301595

11. Liu S, Jones R, Robinson N, Greenwood S, Aplin J, Tower C. (2014). Detrimental effects of ethanol and its metabolite acetaldehyde, on first trimester human placental cell turnover and function. PLoS one. 9(2): e87328. https://doi.org/10.1371/journal.pone.0087328; PMid:24503565 PMCid:PMC3913587

12. Malhotra A, Allison B, Castillo-Melendez M, Jenkin G, Polglase G, Miller S. (2019). Neonatal morbidities of fetal growth restriction: pathophysiology and impact. Front Endocrinol (Lausanne). 7; 10: 55. https://doi.org/10.3389/fendo.2019.00055; PMid:30792696 PMCid:PMC6374308

13. McBurney R. (1947). The undernourished full term infant; a case report. Western J Surg Obstet Gynecol. 55(7): 363-70.

14. Panagiotopoulos M, Tseke P, Michala L. (2021). Obstetric complications in women with congenital uterine anomalies according to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy Classification. Obstetrics and Gynecology. 139(1): 138-148. https://doi.org/10.1097/AOG.0000000000004627; PMid:34856567

15. Papastefanou I, Wright D, Lolos M, Anampousi K, Mamalis M, Nicolaides K. (2021). Competing‐risks model for prediction of small‐for‐gestational‐age neonate from maternal characteristics, serum pregnancy‐associated plasma protein‐A and placental growth factor at 11-13 weeks' gestation. Ultrasound in Obstetrics & Gynecology. 57(3): 392-400. https://doi.org/10.1002/uog.23118; PMid:32936500

16. Sjostedt S, Engleson G, Rooth G. (1958). Dysmaturity. Archives of Disease in Childhood. 33(168): 123-130. https://doi.org/10.1136/adc.33.168.123; PMid:13534744 PMCid:PMC2012212

17. Taylor W, James J, Henderson J. (1952). The significance of yellow vernix in the newborn. Archives of disease in childhood. 27(135): 442-444. doi: 10.1136/adc.27.135.442. https://doi.org/10.1136/adc.27.135.442; PMid:12986852 PMCid:PMC1988570

18. Tousty P, Fraszczyk-Tousty M, Golara A et al. (2023). Screening for Preeclampsia and Fetal Growth Restriction in the First Trimester in Women without Chronic Hypertension. Journal of Clinical Medicine. 12(17): 5582. https://doi.org/10.3390/jcm12175582; PMid:37685649 PMCid:PMC10488103

19. Turan S, Miller J, Baschat A. (2008). Integrated testing and management in fetal growth restriction. Seminars in Perinatology. 32(3): 194-200. https://doi.org/10.1053/j.semperi.2008.02.008; PMid:18482621

20. Tyrrell J, Richmond R, Palmer T et al. (2016). Genetic evidence for causal relationships between maternal obesity-related traits and birth weight. JAMA. 315(11): 1129-1140. https://doi.org/10.1001/jama.2016.1975; PMid:26978208 PMCid:PMC4811305

21. Vadlamudi G, Goyert G, Shaman M. (2022). Growth outcomes of marginal cord insertion stratified by distance from placental margin. American Journal of Obstetrics and Gynecology. 226(1): S245. https://doi.org/10.1016/j.ajog.2021.11.414

22. Wang S, Wang K, Hu Q, Liao H, Wang X, Yu H. (2022). Perinatal outcomes of women with Müllerian anomalies. Archives of Gynecology and Obstetrics. 307(4): 1209-1216. https://doi.org/10.1007/s00404-022-06557-6; PMid:35426514 PMCid:PMC10023634

23. Yang J, Liang M. (2021). Risk factors for pregnancy morbidity in women with antiphospholipid syndrome. Journal of Reproductive Immunology. 145: 103315. https://doi.org/10.1016/j.jri.2021.103315; PMid:33845396

24. Yanyuta GS, Savka TR, Basystiy AV. (2016). Intrauterine growth restriction: diagnosis and perinatal complications Health of woman. 9(115): 99-102. https://doi.org/10.15574/HW.2016.115.99

25. Yarotska Yu, Zahorodnia O. (2021). Morfolohiia platsenty – vid teorii do praktyky. Reproduktyvne zdorov'ia zhinky. 9-10: 67-72.