European Journal of Pediatrics

, Volume 165, Issue 10, pp 717–725 | Cite as

Identification of newborns with Fetal Growth Restriction (FGR) in weight and/or length based on constitutional growth potential

  • Nicole Mamelle
  • Magali Boniol
  • Olivier Rivière
  • Marie O. Joly
  • Georges Mellier
  • Bernard Maria
  • Bernard Rousset
  • Olivier ClarisEmail author
Original Paper


This study was carried out to build statistical models for defining FGR (Fetal Growth Restriction) in weight and/or length after taking growth potential of an infant into account. From a cohort of pregnant women having given birth to 47,733 infants in 141 French maternity units, two statistical models gave individualized limits of birth weight and birth length (based on the 5th centile) below which, after adjustment for its individual growth potential, a newborn must be considered as FGR in weight and/or in length. A sample of 906 infants had measures taken of cord blood growth factors (IGF1, IGFBP3). The FGRW definition (weight<5th centile for growth potential) permitted the identification of infants who presented rates of maternal hypertension (13.6%) and of Apgar score at 5 min<6 (2.9%) higher than in the classical group SGAW (weight<5th centile for sex and gestational age) (9.6% and 2.2% respectively). By combining FGRW and SGAW, a subgroup of infants, not currently recognized as SGA, presented very high rates of maternal hypertension (19.9%) and of low Apgar score (3.9%). Conversely a subgroup of infants, currently recognized as SGAW, had rates as low as in the normal infants group, and had to be considered as “constitutionally small” (that is to say 24% of the SGAW). Combining FGRW and FGRL (length<5th centile of growth potential), 7.6% of infants appeared growth-restricted, and 1.8% appeared constitutionally small in weight and/or in length. The FGRW–FGRL infants showed the lowest mean values of IGF1 (126.2±3.2) and IGFBP3 (0.86±0.03). These new definitions of FGRW and FGRL could help to better identify infants at birth requiring neonatal care, and monitoring of growth catch-up and neurodevelopmental outcome.


FGR Constitutional growth potential Growth factors Gravidic hypertension Long term outcome 



small for gestational age


SGA in weight


SGA in length


intrauterine growth retardation


fetal growth restriction


FGR in weight


normal weight


constitutionally small in weight


FGRW-type I


FGRW-type II


FGR in length


normal length


constitutionally small in length


FGRL-type I


FGRL-type II



This work is dedicated to the memory of Dr J.M. Saez. We are indebted to Dr J.Y. Lebouc (INSERM unit 515, Paris) and to Pr P. Chatelain (Hospices civils de Lyon) for their advice.


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Nicole Mamelle
    • 1
    • 2
    • 7
  • Magali Boniol
    • 3
  • Olivier Rivière
    • 1
    • 2
  • Marie O. Joly
    • 4
  • Georges Mellier
    • 5
  • Bernard Maria
    • 2
  • Bernard Rousset
    • 1
  • Olivier Claris
    • 1
    • 2
    • 6
    Email author
  1. 1.UMR 369 INSERM / Claude Bernard University-Molecular and Cellular Endocrinology Unit – and IFR62, Research group: Epidemiology of growth and developmentFaculté de Médecine LaennecLyonFrance
  2. 2.AUDIPOG (Association des utilisateurs de dossiers informatisés en pédiatrie, obstétrique et gynécologie)Faculté de Médecine LaennecLyonFrance
  3. 3.AUDIVALLyonFrance
  4. 4.Laboratoire central d'anatomie pathologique, Hôpital Edouard HerriotLyonFrance
  5. 5.Department of obstetrics and gynaecology, Hôpital Edouard HerriotLyonFrance
  6. 6.Department of Neonatology, Hôpital Edouard HerriotLyonFrance
  7. 7.UMR 369 INSERM / UCLB – Equipe Epidémiologie, Faculté de Médecine Lyon – R.T.H. LaennecLyon Cedex 08France

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