Fetal Growth and the Risk of Spontaneous Preterm Birth in a Prospective Cohort Study of Nulliparous Women
American Journal of Epidemiology
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Partap, U., Sovio, U., & Smith, G. (2016). Fetal Growth and the Risk of Spontaneous Preterm Birth in a Prospective Cohort Study of Nulliparous Women. American Journal of Epidemiology https://www.repository.cam.ac.uk/handle/1810/253501
Previous studies have suggested an association between fetal growth restriction and the risk of spontaneous preterm birth (sPTB). However, addressing this association is methodologically challenging. We conducted a prospective cohort study of nulliparous women with a singleton pregnancy in Cambridge, UK, 2008-2012. Ultrasonic fetal biometry was performed at 20 weeks of gestation as per routine clinical care. Participants also had blinded research ultrasonography at ~28 weeks. Biometric measurements were expressed as gestational age-adjusted z-scores. Fetal growth velocity was quantified by change in z-score between 20 and 28 weeks. Risk of sPTB, defined as delivery ≥28 and <37 weeks associated with labor in the absence of induction, was analysed using cause-specific Cox regression. 98 (2.5%) of 3,892 women had sPTB. When compared to the rest, the lowest decile of growth velocity of fetal femur between 20 and 28 weeks was associated with increased risk of sPTB (hazard ratio 2.37; 95% confidence interval: 1.43, 3.93; P<0.001). Adjustment for maternal characteristics was without material effect (hazard ratio: 2.50; 95% confidence interval: 1.50, 4.14; P<0.001). There were no significant associations between other fetal measurements and risk of sPTB. To conclude, slow growth velocity of fetal femur is associated with an increased risk of sPTB.
fetal biometry, fetal growth, growth velocity, spontaneous preterm birth
This study was funded by the National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre (grant number A019057) and Stillbirth and Neonatal Death Society (SANDS). UP was funded by the Dr. Herchel Smith Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. GE donated two ultrasound machines for use in the project.
Stillbirth and Neonatal Death Society (SANDS) (JE/DICT4/97771/14)
Cambridge University Hospitals NHS Foundation Trust (CUH) (unknown)
This record's URL: https://www.repository.cam.ac.uk/handle/1810/253501