Fetal growth velocity as a predictor of small for gestational age at birth and adverse perinatal outcomes: systematic review and meta-analysis

Resumo original em inglês

O que aconteceu

This study aimed to evaluate the role of fetal growth velocity in predicting small-for-gestational-age at birth and adverse perinatal outcomes.

A systematic review and meta-analysis was conducted through an electronic search of PubMed, Embase, and CINAHL, including studies published between January 2000 and February 2025.

Both prospective and retrospective studies of pregnancies undergoing longitudinal growth assessment, from the second to the third trimester or within the third trimester, were included.

This study was registered with PROSPERO (International Prospective Register of Systematic Reviews) (CRD42025642750). Pooled sensitivity and pooled specificity with 95% confidence interval and pooled risk estimates were synthesized using random- and fixed-effects models, respectively. Risk of bias was assessed using the Newcastle-Ottawa scale and the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies), whereas certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.

O que encontraram

The electronic search yielded 5.440 citations. Following full-text review of the potentially eligible studies, 21 studies were included. The predictive and risk stratification value of fetal growth velocity for small-for-gestational-age at birth and adverse perinatal outcomes was assessed across cohorts of 185.441 and 164.341 singleton pregnancies, respectively. Slowing fetal growth velocity showed suboptimal predictive performance for small-for-gestational-age at birth, with pooled sensitivity and specificity for abdominal circumference and estimated fetal weight growth velocity (defined as z-scores divided by interval time in days) of 0.22 (95% CI, 0.09-0.44) and 0.92 (95% CI, 0.92-0.95), and 0.55 (95% CI, 0.53-0.56) and 0.96 (95% CI, 0.96-0.96), respectively (GRADE: low). Slowing fetal growth velocity showed a moderate association with adverse perinatal outcomes: abdominal circumference growth velocity <10th centile was associated with composite adverse perinatal outcome among fetuses predicted to be small-for-gestational-age (pooled odds ratio, 2.47; 95% CI, 1.69-3.82), whereas a fixed centile drop in abdominal circumference/estimated fetal weight ≥50 significantly increased the risk of perinatal death, irrespective of estimated fetal weight (pooled odds ratio, 3.92; 95% CI, 2.03-7.58) (GRADE: moderate).

Por que isso importa

Fetal growth velocity might be considered a moderate risk factor for adverse outcomes, but it did not improve prediction over cross-sectional biometry, either at 32 or 36 weeks of gestation, even when implemented in multivariable models. Its clinical utility may lie in complementing third-trimester biometry and maternal/fetal Dopplers in risk stratification. However, standardized definitions and formulas are urgently needed to improve reproducibility and guide implementation in antenatal care.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.