Factors Associated with Fetal Growth Restriction and Small-For-Gestational-Age Fetuses in a Private Tertiary Care Hospital
Main Article Content
Abstract
Objective: To describe risk factors associated with fetal growth restriction (FGR) and small-for-gestational-age (SGA) fetuses and assess their presence in a private tertiary-care hospital population.
Methods: A retrospective observational cohort study included singleton pregnancies diagnosed with impaired fetal growth between April 2018 and September 2022 at a Maternal–Fetal Medicine unit. Cases were classified as early- or late-onset FGR or SGA according to standardized diagnostic criteria. Maternal characteristics, comorbidities, obstetric history, biochemical markers, and neonatal outcomes were analyzed using nonparametric statistics.
Results: Among 143 eligible patients, 15 (10.5%) had early-onset FGR, 47 (32.9%) late-onset FGR, and 81 (56.6%) SGA. Demographic characteristics were similar across groups. Most patients had normal pregestational BMI; however, inadequate gestational weight gain was frequent. Early-onset FGR was associated with significantly lower birthweight (p = 0.000). Preeclampsia correlated with lower neonatal weight, while assisted reproductive technology (ART) pregnancies showed higher mean birthweight.
Conclusions: In this cohort, inadequate gestational weight gain emerged as a frequent potentially modifiable factor. Strengthening nutritional counseling and multidisciplinary prenatal care may improve perinatal outcomes.
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48(3):333–9.
II. Molina LCG, Odibo L, Zientara S, Običan SG, Rodriguez A, Stout M, et al. Validation of Delphi procedure consensus criteria for defining fetal growth restriction. Ultrasound Obstet Gynecol. 2020;56(1):61–6.
III. Melamed N, Baschat A, Yinon Y, Athanasiadis A, Mecacci F, Figueras F, et al. FIGO initiative on fetal growth: best practice advice. Int J Gynecol Obstet. 2021;152(S1):3–57.
IV. Aviram A, Sherman C, Kingdom J, Zaltz A, Barrett J, Melamed N. Defining early vs late fetal growth restriction by placental pathology. Acta Obstet Gynecol Scand. 2019;98(3):365–73.
V. Lees CC, Stampalija T, Baschat A, da Silva Costa F, Ferrazzi E, Figueras F, et al. ISUOG Practice Guidelines: diagnosis and management of SGA and FGR. Ultrasound Obstet Gynecol. 2020;56(2):298–312.
VI. Nardozza LMM, et al. Fetal growth restriction: current knowledge. Arch Gynecol Obstet. 2017;295(5):1061–77.
VII. Rasmussen KM, Yaktine AL. Weight Gain During Pregnancy. National Academies Press; 2009.
VIII. Committee on Obstetric Practice ACOG. Tobacco and Nicotine Cessation During Pregnancy. Obstet Gynecol. 2020;135(5):221–9.
IX. Committee on Practice Bulletins ACOG. Fetal Growth Restriction. Obstet Gynecol. 2019;133(76):168–86.
X. Zur RL, Kingdom JC, Parks WT, Hobson SR. The Placental Basis of FGR. Obstet Gynecol Clin North Am. 2020;47(1):81–98.
XI. Albu AR, et al. Predictive factors for intrauterine growth restriction. J Med Life. 2014;7(2):165–71.
XII. Longo S, et al. IUGR and infections. Early Hum Dev. 2014;90(S1):S42–4.
XIII. Maulik D. Fetal growth restriction: The etiology. Clin Obstet Gynecol. 2006;49(2):228–35.
XIV. Meher S, et al. Antiplatelet therapy before or after 16 weeks. Am J Obstet Gynecol. 2017;216(2):121–128.
XV. Smith GCS. Universal screening for FGR. Best Pract Res Clin Obstet Gynaecol. 2018;49:16–28.
XVI. Cignini P, et al. Predictive value of PAPP-A and free β-hCG on FGR. Arch Gynecol Obstet. 2016;293(6):1227–33.
XVII. Chaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening. Am J Obstet Gynecol. 2022;226(2):S1071–S1097.
XVIII. Pallotto EK, Kilbride HW. Perinatal outcome and implications of IUGR. Clin Obstet Gynecol. 2006;49(2):257–69.
XIX. Moreno-Fernandez J, et al. Early nutrition and fetal programming. Nutrients. 2020;12(12).
XX. Wei Y, Schatten H, Sun QY. Environmental epigenetic inheritance. Hum Reprod Update. 2015;21(2):194–208.
XXI. Lane RH. Fetal programming and adult disease. Clin Perinatol. 2014;41(4):815–31.
XXII. Lean SC, et al. Placental dysfunction and advanced maternal age. Sci Rep. 2017;7(1).
XXIII. Leader J, et al. Very advanced maternal age outcomes. J Obstet Gynaecol Canada. 2018;40(9):1208–18.
XXIV. Robillard PY, et al. Primipaternities and birthweights. J Reprod Immunol. 2021;147.
XXV. Marshall NE, et al. Nutrition in pregnancy and lifelong consequences. Am J Obstet Gynecol. 2022;226(5):607–32.
XXVI. Blue NR, Page JM, Silver RM. Recurrence risk of FGR. Obstet Gynecol Clin North Am. 2021;48(2):419–36.
XXVII. Serakides R, et al. FGR in hypothyroidism. Reprod Fertil Dev. 2012;24(7):923–31.
XXVIII. Santiago M, et al. Smoking in pregnancy prevalence. Rev Esp Salud Pública. 2013;30(1):37–40.
XXIX. Dutta S, et al. Molecular targets of aspirin in pregnancy. Int J Mol Sci. 2019;20(18).
XXX. Manna C, et al. Placental dysfunction in ART pregnancies. Int J Mol Sci. 2022;23(2).