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Fetal growth restriction must be better recognised

Raises a baby’s stillbirth risk by four times, or eight times if undetected

Louise Prime

Friday, 25 January 2013

Fetal growth restriction is the single most important factor in stillbirth, especially when it is unrecognised before birth – but it is missed in most pregnancies, research has shown.

Authors of the UK study, published online today on bmj.com, calculated that recognising fetal growth restriction early could reduce the number of stillbirths in the UK by 600 a year. They said: “Better antenatal detection needs to become a cornerstone and key indicator of safety and effectiveness in maternity care.”

The UK has one of the worst rates of stillbirths – which have often been regarded as largely unexplained and unavoidable – in the developed world. Researchers in Birmingham investigated maternal and fetal risk factors associated with stillbirth and looked at how much difference could be made by modifying these.

They examined NHS records of 92,218 normally formed singleton babies, including 389 stillbirths, delivered during 2009-11 at 24 weeks’ gestation or later.

Risk factors associated with an increased risk of stillbirth were: first, third and subsequent pregnancies compared with second pregnancies; African, African-Caribbean, Indian and Pakistani ethnicity; deprivation and unemployment of the mother or her partner; maternal BMI of 30 or more; smoking; pre-existing diabetes; history of mental health problems; antepartum haemorrhage in the current pregnancy; and fetal growth restriction. High maternal age carried no increased risk.

Maternal obesity, smoking in pregnancy and fetal growth restriction – all of which are potentially modifiable – accounted for 56% of all stillbirths in this study. Fetal growth restriction alone was associated with a fourfold increased risk of stillbirth; this rose to eightfold if it remained undetected during pregnancy, accounting for almost a third (32%) of all stillbirths in this study.

The authors said: “Our study shows that while there are several risk factors for stillbirth that can be ascertained from the outset of pregnancy, the single largest factor is fetal growth restriction, which is currently not well predicted and not recognised antenatally in most pregnancies.”

They estimated that 71 of the stillbirths in their study could have been avoided by recognising fetal growth restriction antenatally, which they calculated would mean 600 fewer stillbirths a year for the whole UK population.

They concluded: “Most normally formed singleton stillbirths are potentially avoidable. The single largest risk factor is unrecognised fetal growth restriction, and preventive strategies need to focus on improving antenatal detection.”

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