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Profile of severely growth-restricted births undelivered at 40 weeks in Western Australia

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

An Author Correction to this article was published on 22 July 2020

This article has been updated

Abstract

Purpose

To investigate the proportion of severely growth-restricted singleton births < 3rd percentile (proxy for severe fetal growth restriction; FGR) undelivered at 40 weeks (FGR_40), and compare maternal characteristics and outcomes of FGR_40 births and FGR births at 37–39 weeks’ (FGR_37–39) to those not born small-for-gestational-age at term (Not SGA_37+).

Methods

The annual rates of singleton FGR_40 births from 2006 to 2015 were calculated using data from linked Western Australian population health datasets. Using 2013–2015 data, maternal factors associated with FGR births were investigated using multinomial logistic regression to estimate odds ratios (OR) with 95% confidence intervals (CI) while relative risks (RR) of birth outcomes between each group were calculated using Poisson regression. Neonatal adverse outcomes were identified using a published composite indicator (diagnoses, procedures and other factors).

Results

The rate of singleton FGR_40 births decreased by 23.0% between 2006 and 2015. Factors strongly associated with FGR_40 and FGR_37–39 births compared to Not SGA_37+ births included the mother being primiparous (ORs 3.13: 95% CI 2.59–3.79; 1.69, 95% CI 1.47, 1.94, respectively) and ante-natal smoking (ORs 2.55, 95% CI 1.97, 3.32; 4.48, 95% CI 3.74, 5.36, respectively). FGR_40 and FGR_37–39 infants were more likely to have a neonatal adverse outcome (RRs 1.70, 95% CI 1.41, 2.06 and 2.46 95% CI 2.18, 2.46, respectively) compared to Not SGA 37+ infants.

Conclusions

Higher levels of poor perinatal outcomes among FGR births highlight the importance of appropriate management including fetal growth monitoring. Regular population-level monitoring of FGR_40 rates may lead to reduced numbers of poor outcomes.

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Change history

  • 22 July 2020

    Unfortunately, after publication, we found errors in the extraction of data on gestational diabetes and threatened miscarriage.

Abbreviations

CI:

Confidence interval

LHT:

Linear hypothesis test

MNS:

Midwives Notification System

Not SGA 37+:

Birth at 37 or more weeks’ gestation without SGA

OR:

Odds ratio

RCOG:

Royal College of Obstetricians and Gynaecologists

RR:

Relative risk

SGA:

Small-for-gestational-age

FGR:

Fetal growth restriction (< 3rd percentile)

FGR_37–39:

Severely growth-restricted birth delivered at 37–39 weeks’ gestation

FGR_40:

Severely growth-restricted birth undelivered at 40 weeks’ gestation

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Acknowledgements

We would like to acknowledge the Data Linkage Branch (Western Australian Government Department of Health), the custodians of the Midwives’ Notification System, Birth and Death Registries, Hospital Morbidity Data Collection and Western Australian Register of Developmental Anomalies for providing data for this project. In particular, we acknowledge Dr Rosi Katich, Senior Coding Consultant, WA Clinical Coding Authority (WA Department of Health) who advised us on the International Classification of Diseases-10-AM classification in relation to the neonatal adverse outcome index. We also acknowledge Dr Samantha Lain, Children’s Hospital at Westmead Clinical School, University of Sydney, who developed the neonatal adverse outcome index and provided advice about it.

Funding

This research was supported by funding from an Australian National Health and Medical Research Council (NHMRC) Project Grant (GNT1127265) which funded AAA, HDB, BMF and CCJS. Research at UCL Great Ormond Street Institute of Child Health is supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre (PH).

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Authors and Affiliations

  1. Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia

    Helen D. Bailey, Akilew A. Adane, Brad M. Farrant & Carrington C. J. Shepherd

  2. Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, WA, Australia

    Scott W. White

  3. Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia

    Scott W. White

  4. Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, UK

    Pia Hardelid

  5. Ngangk Yira Research Centre for Aboriginal Health & Social Equity, Murdoch University, Murdoch, WA, Australia

    Carrington C. J. Shepherd

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Contributions

HDB: project development, data management and analysis, manuscript writing; AAA, BMF, SWW, PH: critical revision of the manuscript; CCJS: project development, critical revision of the manuscript. All authors reviewed and approved the final version.

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Correspondence to Helen D. Bailey.

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All authors declare no competing interests.

Ethical approval

All procedures performed were in accordance with the ethical standards of Western Australian Department of Health Human Ethics Research Committee and the Western Australian Aboriginal Health Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Consent for the study was obtained from the data custodians. As the study was based on routinely collected anonymised population health data, individual consent from the participants was not obtained.

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Bailey, H.D., Adane, A.A., Farrant, B.M. et al. Profile of severely growth-restricted births undelivered at 40 weeks in Western Australia. Arch Gynecol Obstet 301, 1383–1396 (2020). https://doi.org/10.1007/s00404-020-05537-y

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