Fetal growth restriction(FGR)is the condition in which a fetus does not reach its intrinsic growth potential and in which the shortterm and long-term risks of severe complications are increased.FGR is a frequent compl...Fetal growth restriction(FGR)is the condition in which a fetus does not reach its intrinsic growth potential and in which the shortterm and long-term risks of severe complications are increased.FGR is a frequent complication of pregnancy with a complex etiology and limited management options,other than timely delivery.The most common pathophysiological mechanism is placental insufficiency,due to many underlying causes such as maternal vascular malperfusion,fetal vascular malperfusion and villitis.Identifying truly growth restricted fetuses remains challenging.To date,FGR is often defined by a cut-off of the estimated fetal weight below a certain percentile on a population-based standard.However,small fetal size as a single marker does not discriminate adequately between fetuses or newborns that are constitutionally small but healthy and fetuses or newborns that are growth restricted and thus at risk for adverse outcomes.In 2016,the consensus definition of FGR was internationally accepted to better pinpoint the FGR population.In this review we will discuss the contemporary diagnosis and management issues.Different diagnostic markers are considered,like Doppler measurements,estimated fetal growth,interval growth,fetal movements,biomarkers,and placental markers.展开更多
Fetal growth restriction(FGR)has a prevalence of about 10%worldwide and is associated with an increased risk of perinatal mortality and morbidity.FGR is commonly caused by placental insufficiency and can begin early(&...Fetal growth restriction(FGR)has a prevalence of about 10%worldwide and is associated with an increased risk of perinatal mortality and morbidity.FGR is commonly caused by placental insufficiency and can begin early(<32 weeks)or in late(≥32 weeks)gestational age.A false positive antenatal diagnosis may lead to unnecessary monitoring and interventions,as well as cause maternal anxiety.Whereas a false negative diagnosis exposes the fetus to an increased risk of stillbirth and renders the pregnancy ineligible from the appropriate care and potential treatments.The clinical management of FGR pregnancies faces a complex challenge of deciding on the optimal timing of delivery as currently the main solution is to deliver the baby early,but iatrogenic preterm delivery of infants is associated with adverse short-and long-term outcomes.Early and accurate diagnosis of FGR could aid in better stratification of clinical management,and the development and implementation of treatment options,ultimately benefiting clinical care and potentially improving both short-and long-term health outcomes.The aim of this review is to present the new insights on biomarkers of placenta insufficiency,including their current and potential value of biomarkers in the prediction and prevention for FGR,and highlight the association between biomarkers and adverse outcomes in utero to explore the specific mechanism of impaired fetal growth that establish the basis for disease later in life.展开更多
文摘Fetal growth restriction(FGR)is the condition in which a fetus does not reach its intrinsic growth potential and in which the shortterm and long-term risks of severe complications are increased.FGR is a frequent complication of pregnancy with a complex etiology and limited management options,other than timely delivery.The most common pathophysiological mechanism is placental insufficiency,due to many underlying causes such as maternal vascular malperfusion,fetal vascular malperfusion and villitis.Identifying truly growth restricted fetuses remains challenging.To date,FGR is often defined by a cut-off of the estimated fetal weight below a certain percentile on a population-based standard.However,small fetal size as a single marker does not discriminate adequately between fetuses or newborns that are constitutionally small but healthy and fetuses or newborns that are growth restricted and thus at risk for adverse outcomes.In 2016,the consensus definition of FGR was internationally accepted to better pinpoint the FGR population.In this review we will discuss the contemporary diagnosis and management issues.Different diagnostic markers are considered,like Doppler measurements,estimated fetal growth,interval growth,fetal movements,biomarkers,and placental markers.
基金funded by the National Natural Science Foundation of China(grant number 2018YFC1004604).
文摘Fetal growth restriction(FGR)has a prevalence of about 10%worldwide and is associated with an increased risk of perinatal mortality and morbidity.FGR is commonly caused by placental insufficiency and can begin early(<32 weeks)or in late(≥32 weeks)gestational age.A false positive antenatal diagnosis may lead to unnecessary monitoring and interventions,as well as cause maternal anxiety.Whereas a false negative diagnosis exposes the fetus to an increased risk of stillbirth and renders the pregnancy ineligible from the appropriate care and potential treatments.The clinical management of FGR pregnancies faces a complex challenge of deciding on the optimal timing of delivery as currently the main solution is to deliver the baby early,but iatrogenic preterm delivery of infants is associated with adverse short-and long-term outcomes.Early and accurate diagnosis of FGR could aid in better stratification of clinical management,and the development and implementation of treatment options,ultimately benefiting clinical care and potentially improving both short-and long-term health outcomes.The aim of this review is to present the new insights on biomarkers of placenta insufficiency,including their current and potential value of biomarkers in the prediction and prevention for FGR,and highlight the association between biomarkers and adverse outcomes in utero to explore the specific mechanism of impaired fetal growth that establish the basis for disease later in life.
