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      Care-Related and Maternal Risk Factors Associated with the Antenatal Nondetection of Intrauterine Growth Restriction: A Case-Control Study from Bremen, Germany

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          Abstract

          Objective. To identify care-related and maternal risk factors for the antenatal nondetection of IUGR. Methods. In this hospital-based case-control study we compared antenatally undetected IUGR neonates (cases) to detected IUGR neonates (controls). Data were collected using newborn documentation sheets and standardized personal interviews with the mothers. We calculated antenatal detection rates and used uni- and multivariable logistic regression models to assess the association of antenatal nondetection of IUGR and maternal and care-related factors. Results. A total of 161 neonates from three hospitals were included in the study. Suboptimal fetal growth was identified antenatally in n = 77 pregnancies while in n = 84 it was not detected antenatally (antenatal detection rate: 47.8%). Severity of IUGR, maternal complications, and a Doppler examination during the course of pregnancy were associated with IUGR detection. We did not find statistically significant differences regarding parental socioeconomic status and maternal migration background. Conclusions. In our study, about half of all pregnancies affected by suboptimal growth remained undetected. Future in-depth studies with larger study populations should further examine factors that could increase antenatal detection rates for IUGR.

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          Most cited references31

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          Maternal and fetal risk factors for stillbirth: population based study

          Objective To assess the main risk factors associated with stillbirth in a multiethnic English maternity population. Design Cohort study. Setting National Health Service region in England. Population 92 218 normally formed singletons including 389 stillbirths from 24 weeks of gestation, delivered during 2009-11. Main outcome measure Risk of stillbirth. Results Multivariable analysis identified a significant risk of stillbirth for parity (para 0 and para ≥3), ethnicity (African, African-Caribbean, Indian, and Pakistani), maternal obesity (body mass index ≥30), smoking, pre-existing diabetes, and history of mental health problems, antepartum haemorrhage, and fetal growth restriction (birth weight below 10th customised birthweight centile). As potentially modifiable risk factors, maternal obesity, smoking in pregnancy, and fetal growth restriction together accounted for 56.1% of the stillbirths. Presence of fetal growth restriction constituted the highest risk, and this applied to pregnancies where mothers did not smoke (adjusted relative risk 7.8, 95% confidence interval 6.6 to 10.9), did smoke (5.7, 3.6 to 10.9), and were exposed to passive smoke only (10.0, 6.6 to 15.8). Fetal growth restriction also had the largest population attributable risk for stillbirth and was fivefold greater if it was not detected antenatally than when it was (32.0% v 6.2%). In total, 195 of the 389 stillbirths in this cohort had fetal growth restriction, but in 160 (82%) it had not been detected antenatally. Antenatal recognition of fetal growth restriction resulted in delivery 10 days earlier than when it was not detected: median 270 (interquartile range 261-279) days v 280 (interquartile range 273-287) days. The overall stillbirth rate (per 1000 births) was 4.2, but only 2.4 in pregnancies without fetal growth restriction, increasing to 9.7 with antenatally detected fetal growth restriction and 19.8 when it was not detected. Conclusion 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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            The Adequacy of Prenatal Care Utilization Index: its US distribution and association with low birthweight.

            The proposed Adequacy of Prenatal Care Utilization Index is applied to data from the 1980 National Natality Survey to assess the adequacy of prenatal care utilization and its association with low birthweight in the United States. The index suggests that only 61.1% of women received adequate prenatal care, including 17.7% with more intensive care; 16.7% received inadequate care. More White women (63.4%) than Black women (51.9%) received adequate prenatal care. Low-birthweight rates were elevated among women with inadequate prenatal care and among those who received more intensive prenatal care.
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              Doppler assessment of the fetus with intrauterine growth restriction.

              We sought to provide evidence-based guidelines for utilization of Doppler studies for fetuses with intrauterine growth restriction (IUGR).
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                Author and article information

                Journal
                Biomed Res Int
                Biomed Res Int
                BMRI
                BioMed Research International
                Hindawi
                2314-6133
                2314-6141
                2017
                4 April 2017
                : 2017
                : 1746146
                Affiliations
                1Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
                2Federal Institute for Occupational Safety and Health (BAuA), Dortmund, Germany
                3Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
                4Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Links der Weser, Bremen, Germany
                5Health Sciences Bremen, University of Bremen, Bremen, Germany
                Author notes
                *Sinja Alexandra Ernst: ernst@ 123456leibniz-bips.de

                Academic Editor: Enrico Grisan

                Author information
                http://orcid.org/0000-0002-8111-7918
                Article
                10.1155/2017/1746146
                5394345
                bffb1c9b-9a02-4976-93bc-d87fe6efe494
                Copyright © 2017 Sinja Alexandra Ernst et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 January 2017
                : 16 March 2017
                Funding
                Funded by: Bundesministerium für Bildung und Forschung
                Award ID: 01GY1131
                Categories
                Research Article

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