Intrauterine Growth Restriction: Prevalence Rate, Associated Risk Factors and Perinatal Outcomes at Maternity Teaching Hospital in Erbil/Iraq

Sanarya Jafa  Jamal; Ariana Khalis  Jawad

doi:10.56056/

Authors

Sanarya Jafa Jamal MBChB, Ministry of Health, Maternity Teaching Hospital, Erbil city, Kurdistan region, Iraq.
Ariana Khalis Jawad MBChB, CABAG, FIBMS; Professor in Obstetrics & Gynecology Kurdistan Higher Council of Medical Specialties Erbil city, Kurdistan region, Iraq

DOI:

https://doi.org/10.56056/

Keywords:

Intrauterine growth restriction, Perinatal outcomes, Risk factors

Abstract

Background and objectives: Intrauterine growth restriction is well known cause for fetal morbidity and mortality all over the world especially in developing countries. The aim of this study was to assess the prevalence rate, risk factors and perinatal outcomes for intrauterine growth restriction in a hospital setting.

Methods: A case control study design was conducted to estimate the prevalence rate of intrauterine growth restriction to assess the associated risk factors and perinatal outcomes in Maternity Teaching Hospital in Erbil city-Kurdistan region/Iraq from 1^st of January to 31^st of December, 2023.The perinatal outcomes were assessed in 221 pregnant women with intrauterine growth retardation and 419 healthy pregnant women who served controls.

Results: Intrauterine growth restriction in the study setting was (11.16/1000) total births. The common risk factors of intrauterine growth restriction were low maternal body mass index (p<0.001), nulliparity (p<0.001), positive smoking history (p<0.001), maternal medical disorders (p<0.001) and poor obstetrical history (p≤0.05) were statistically significant. The main adverse perinatal outcomes of intrauterine growth restriction were prematurity (p<0.001), low Apgar scores at 1 minute & at 5 minutes and very low birth weight (p≤0,001).

Conclusions: IUGR is a relatively prevalent obstetric problem & it is significantly related to the adverse perinatal outcomes.

Downloads

Download data is not yet available.

References

1. Sacchi C, Marino C, Nosarti C, Vieno A, Visentin S, Simonelli A. Association of Intrauterine Growth Restriction and Small for Gestational Age Status with Childhood Cognitive Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatrics 2020; 174(8): 772-781.

2. Henrichs J, de Jonge A, Westerneng M, Verfaille V, Franx A, van der Horst HE, et al; IRIS Study Group. Cost-Effectiveness of Routine Third Trimester Ultrasound Screening for Fetal Growth Restriction Compared to Care as Usual in Low-Risk Pregnancies: A Pragmatic Nationwide Stepped-Wedge Cluster-Randomized Trial in The Netherlands (the IRIS Study). Int. J. Environ. Res. Public Health 2022; 19(6): 3312.

3. Damhuis SE, Ganzevoort W, Gordijn SJ. Abnormal Fetal Growth: Small for Gestational Age, Fetal Growth Restriction, Large for Gestational Age: Definitions and Epidemiology. Obstet Gynecol Clin North Am 2021; 48(2):267-279.

4. de Onis M, Blossner M, Villar J. Levels and patterns of intrauterine growth retardation in developing countries. Eur J ClinNutr. 1998,52: S83-S93.

5. World Health Organization & United Nations Children's Fund (‎UNICEF)‎. (‎2004)‎. Low birth weight: country, regional and global estimates. World Health Organization. Available from: https://iris.who.int/handle/10665/43184/

6. Armengaud JB, Yzydorczyk C, Siddeek B, Peyter AC, Simeoni U. Intrauterine growth restriction: Clinical consequences on health and disease at adulthood. Reprod Toxicol 2021; 99:168-76.

7. Nüsken E, Appel S, Saschin L, Kuiper-Makris C, Oberholz L, Schömig C, et al. Intrauterine Growth Restriction: Need to Improve Diagnostic Accuracy and Evidence for a Key Role of Oxidative Stress in Neonatal and Long-Term Sequelae. Cells 2024; 13(6):501.

8. De Farias Aragão VM, Barbieri MA, Moura Da Silva AA, Bettiol H, Ribeiro VS. Risk factors for intrauterine growth restriction: a comparison between two Brazilian cities. Pediatr Res 2005; 57(5 Pt 1):674-79.

9. Dapkekar P, Bhalerao A, Kawathalkar A, Vijay N. Risk Factors Associated with Intrauterine Growth Restriction: A Case-Control Study. Cureus 2023; 15(6): e40178.

10. Pennington KA, Schlitt JM, Jackson DL, Schulz LC, Schust DJ. Preeclampsia: multiple approaches for a multifactorial disease. Dis Model Mech 2012; 5(1):9-18.

11. Baschat AA. Doppler application in the delivery timing of the preterm growth-restricted fetus: another step in the right direction. Ultrasound Obstet Gynecol 2004; 23(2):111-118.

12. Naveen D, Karthikeyan K. Prediction of perinatal morbidity in IUGR pregnancies using doppler blood flow studies. IJCMSR 2019; 4(3):C82-C85.

13. Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 2014; 36(2):86-98.

14. Vogel JP, Vannevel V, Robbers G, Gwako G, Lavin T, Adanikin A, et al. Prevalence of abnormal umbilical arterial flow on Doppler ultrasound in low-risk and unselected pregnant women: a systematic review. Reprod Health 2021; 18(1):38.

15. Baschat AA. Fetal growth restriction - from observation to intervention. J Perinat Med 2010; 38(3):239-46.

16. Tolu LB, Ararso R, Abdulkadir A, Feyissa GT, Worku Y. Perinatal outcome of growth restricted fetuses with abnormal umbilical artery Doppler waveforms compared to growth restricted fetuses with normal umbilical artery Doppler waveforms at a tertiary referral hospital in urban Ethiopia. PloS one 2020; 15(6): e0234810.

17. Morris RK, Johnstone E, Lees C, Morton V, Smith G; Royal College of Obstetricians and Gynaecologists. Investigation and Care of a Small-for-Gestational-Age Fetus and a Growth Restricted Fetus (Green-top Guideline No. 31). BJOG 2024; 131(9): e31-e80.

18. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363(9403):157-163.

19. World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience: Summary. WHO 2016. Available from: https://www.who.int/publications/i/item/9789241549912/

20. ACOG Committee Opinion No 579: Definition of term pregnancy. Obstet Gynecol 2013; 122(5):1139-1140.

21. American academy of pediatrics committee on fetus and newborn; American college of obstetricians and Gynecologists committee on obstetric practice. The Apgar Score Pediatrics 2015; 136(4):819-822.

22. Cutland CL, Lackritz EM, Mallett-Moore T, Bardají A, Chandrasekaran R, Lahariya C, et al; Brighton Collaboration Low Birth Weight Working Group. Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2017; 35(48 Pt A):6492-6500.

23. Dankul W, Ratasathien L, Inchit C. Trend, incidence and factors detecting intrauterine growth restriction. SWU (JS&T) 2021 ; 13 :123-35. Available from: https://ph02.tci-thaijo.org/index.php/swujournal/article/view/246643/

24. Alisjahbana B, Rivami DS, Octavia L, Susilawati N, Pangaribuan M, Alisjahbana A, et al. Intrauterine growth retardation (IUGR) as determinant and environment as modulator of infant mortality and morbidity: the Tanjungsari Cohort Study in Indonesia. Asia Pac J Clin Nutr 2019; 28(Suppl 1): S17-S31.

25. Unterscheider J, O'Donoghue K, Daly S, Geary MP, Kennelly MM, McAuliffe FM, et al. Fetal growth restriction and the risk of perinatal mortality-case studies from the multicentre PORTO study. BMC Pregnancy Childbirth 2014; 14:63.

26. Saleem T, Sajjad N, Fatima S, Habib N, Ali SR, Qadir M. Intrauterine growth retardation--small events, big consequences. Ital J Pediatr 2011; 37:41.

27. Patibandla S, Ansari AZ, Brown SF. Intrauterine Growth Restriction and Placenta Previa: A Clinical Case Report of an Advanced-Age Pregnancy. Cureus 2024; 16(2): e54896.

28. Dinu M, Badiu AM, Hodorog AD, Stancioi-Cismaru AF, Gheonea M, Grigoras Capitanescu R, et al. Early Onset Intrauterine Growth Restriction-Data from a Tertiary Care Center in a Middle-Income Country. Medicina (Kaunas) 2022; 59(1):17.

29. Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr 2016; 10:67-83.

30. Melamed N, Baschat A, Yinon Y, Athanasiadis A, Mecacci F, Figueras F, et al. FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction. Int J Gynaecol Obstet 2021; 152 Suppl 1(Suppl 1):3-57.

31. Mutar SA. Intrauterine Growth Restriction is Frequent Obstetric Problem in Mid-Euphrates Region of Iraq: a Case Control Study. Indian J Public Health Res Dev. 2019; 10(4):622-626.

32. Al-Sadi EK, Alawqatii TA. Disparities of Clinical Features and Associated Maternal Factors among Symmetrical and a Symmetrical Intra-Uterine Growth Restriction (IUGR) in NICU at AlYarmouk Teaching Hospital in Baghdad, Iraq. Int J Pediatr 2018; 6(6): 7815-7822.

33. Sainky A, Nayar S, Sharma N, Gupta ND, Modi M, Mansukhani C, et al. Perinatal Outcomes of Fetal Growth Restriction, Classifed According to the Delphi Consensus Defnition: A Prospective Observational Study. J Fetal Med 2022; 9:113–119.