Ultrasound prediction of fetal growth abnormalities and association with maternal and neonatal adverse outcomes

First, I present the background and existing gaps in the literature that led to this work. While there is extensive literature on how best to manage pregnancies with a small for gestational age (SGA) fetus, there is uncertainty as to the best approach for identifying SGA and large for gestational age (LGA) fetuses. In addition, despite vast literature reporting on the adverse outcomes associated with fetal macrosomia, there is significant heterogeneity in published studies and therefore no clear guidance about accurate evidence-based estimates of maternal and neonatal risks.

Second, I will outline a critical commentary and discussion for my five publications, describing the innovative concepts utilized to address the problem outlined above. In each publication, I will highlight the objectives, my contribution, the key findings, and the impact of the research. The first study investigates the optimal timing of a routine third trimester ultrasound scan in predicting SGA neonates. It demonstrates that the predictive performance is better at 35+0 to 36+6 weeks’ gestation, using estimated fetal weight (EFW) as the screening method, and an outcome measure of birth weight (BW) less than the 3rd percentile.

The second study addresses the optimal timing of a routine third trimester ultrasound scan to predict a LGA neonate and shows that the predictive performance is higher at 36 weeks’ gestation, using EFW as the method of screening, with an outcome measure of BW more than the 97th percentile. The study proposes a two-stage strategy for maximizing the prenatal prediction of a LGA neonate.

The following two studies, establish accurate odds ratios (ORs) for the maternal and neonatal complications in pregnancies with fetal macrosomia. The systematic review and metaanalysis, provide evidence-based estimates of these risks which can be used for decisions on pregnancy management.

The fifth study, examines how the impact of the new definitions of pre-eclampsia (PE), affect the incidence and severity of the disease, the performance of the competing-risks model for first-trimester assessment of risk for PE, and therefore the subsequent effect on detecting SGA neonates. The study demonstrates that the new definitions of PE result in an increase in pregnancies classified as having PE, but that there is a non-significant decrease in the performance of first-trimester screening for PE.

I believe my substantial contribution to these studies has significantly progressed the accurate ultrasound prediction of small and large babies. I have established accurate risk estimates of the maternal and neonatal complications associated with fetal macrosomia. This enables clinicians to monitor intrauterine growth effectively, offer patient education, and ultimately reduce the adverse outcomes in pregnancies marked by abnormal fetal growth.