title: Poor effectiveness of antenatal detection of fetal growth restriction and consequences for obstetric management and neonatal outcomes: a French national study.
abstract: OBJECTIVE
  To assess the proportion of small for gestational age (SGA) and normal birthweight infants suspected of fetal growth restriction (FGR) during pregnancy, and to investigate obstetric and neonatal outcomes by suspicion of FGR and SGA status at birth.
  
  
  METHODS
  Population-based study.
  
  
  METHODS
  All French maternity units in 2010.
  
  
  METHODS
  Representative sample of singleton births (n = 14,100).
  
  
  METHODS
  We compared SGA infants with a birthweight of less than the 10th percentile suspected of FGR, defined as mention of FGR in medical charts (true positives), non-SGA infants suspected of FGR (false positives), SGA infants without suspicion of FGR (false negatives) and non-SGA infants without suspicion of FGR (true negatives). Multivariable analyses were adjusted for maternal and neonatal characteristics hypothesised to affect closer surveillance for FGR and our outcomes.
  
  
  METHODS
  Obstetric management (caesarean, provider-initiated preterm and early term delivery) and neonatal outcomes (late fetal death, preterm birth, Apgar score, resuscitation at birth).
  
  
  RESULTS
  21.7% of SGA infants (n = 265) and 2.1% of non-SGA infants (n = 271) were suspected of FGR during pregnancy. Compared with true negatives, provider-initiated preterm deliveries were higher for true and false positives (adjusted risk ratio [aRR], 6.1 [95% CI, 3.8-9.8] and 4.6 [95% CI, 3.2-6.7]), but not for false negatives (aRR, 1.1 [95% CI, 0.6-1.9]). Neonatal outcomes were not better for SGA infants if FGR was suspected.
  
  
  CONCLUSIONS
  Antenatal suspicion of FGR among SGA infants was low and one-half of infants suspected of FGR were not SGA. The increased risk of provider-initiated delivery observed in non-SGA infants suspected of FGR raises concerns about the iatrogenic consequences of screening.
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Monier
authors.forename: B
authors.initials: B
authors.lastname: Blondel
authors.forename: A
authors.initials: A
authors.lastname: Ego
authors.forename: M
authors.initials: M
authors.lastname: Kaminiski
authors.forename: F
authors.initials: F
authors.lastname: Goffinet
authors.forename: J
authors.initials: J
authors.lastname: Zeitlin
mesh_terms: D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D036861:Delivery, Obstetric; D005189:False Positive Reactions; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis* / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis
keywords: Antenatal detection; fetal growth restriction; obstetric management; small for gestational age