Early rapid growth, early birth: accelerated fetal growth and spontaneous late preterm birth.
The past two decades in the United States have seen a 24% rise in spontaneous late preterm delivery (34-36 weeks) of unknown etiology. This study tested the hypothesis that fetal growth was identical prior to spontaneous preterm (n = 221, median gestational age at birth 35.6 weeks) and term (n = 3706) birth among pregnancies followed longitudinally in Santiago, Chile. The hypothesis was not supported: Preterm-delivered fetuses were significantly larger than their term-delivered peers by mid-second trimester in estimated fetal weight, head, limb, and abdominal dimensions, and they followed different growth trajectories. Piecewise regression assessed time-specific differences in growth rates at 4-week intervals from 16 weeks. Estimated fetal weight and abdominal circumference growth rates slowed at 20 weeks among the preterm-delivered, only to match and/or exceed their term-delivered peers at 24-28 weeks. After an abrupt growth rate decline at 28 weeks, fetuses delivered preterm did so at greater population-specific sex and age-adjusted birth weight percentiles than their peers from uncomplicated pregnancies (P < 0.01). Growth rates predicted birth timing: one standard score of estimated fetal weight increased the odds ratio for late preterm birth from 2.8 prior to 23 weeks, to 3.6 (95% confidence interval, 1.82-7.11, P < 0.05) between 23 and 27 weeks. After 27 weeks, increasing size was protective (OR: 0.56, 95% confidence interval, 0.38-0.82, P = 0.003). These data document, for the first time, a distinctive fetal growth pattern across gestation preceding spontaneous late preterm birth, identify the importance of mid-gestation for alterations in fetal growth, and add perspective on human fetal biological variability.
Lampl
Michelle
M
Department of Anthropology, Emory University, Atlanta, Georgia 30322, USA.
Kusanovic
Juan Pedro
JP
Erez
Offer
O
Espinoza
Jimmy
J
Gotsch
Francesca
F
Goncalves
Luis
L
Hassan
Sonia
S
Gomez
Ricardo
R
Nien
Jyh Kae
JK
Frongillo
Edward A
EA
Romero
Roberto
R
D001699:Biometry; D002677:Chile; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn / Q000254:growth & development*; D007234:Infant, Premature / Q000254:growth & development*; D008137:Longitudinal Studies; D007752:Obstetric Labor, Premature; D010641:Phenotype; D011247:Pregnancy; D047928:Premature Birth; D016016:Proportional Hazards Models; D012189:Retrospective Studies