Validation of Delphi procedure consensus criteria for defining fetal growth restriction.

OBJECTIVE: Recently, a Delphi procedure was used to establish new criteria for defining fetal growth restriction (FGR). These criteria require clinical validation. We sought to validate the Delphi consensus criteria by comparing their performance with that of our current definition (estimated fetal weight (EFW) < 10th percentile) in predicting adverse neonatal outcome (ANO). METHODS: This was a secondary analysis of data from a prospective cohort study of women referred for fetal growth assessment between 26 and 36 weeks' gestation. The current standard definition of FGR used in our clinical practice is EFW < 10th percentile using Hadlock's fetal growth standard. The Delphi consensus criteria for FGR include either a very small fetus (abdominal circumference (AC) or EFW < 3rd percentile) or a small fetus (AC or EFW < 10th percentile) with additional abnormal Doppler findings or a decrease in AC or EFW by two quartiles or more. The primary outcome was the prediction of a composite of ANO including one or more of: admission to the neonatal intensive care unit, cord pH < 7.1, 5-min Apgar score < 7, respiratory distress syndrome, intraventricular hemorrhage, neonatal seizures or neonatal death. The discriminatory capacities of the two definitions of FGR for composite ANO and delivery of a small-for-gestational-age (SGA) neonate, defined as birth weight < 10th percentile, were compared using area under the receiver-operating-characteristics curve (AUC). The sensitivity, specificity and predictive values of the methods were also compared. RESULTS: Of 1055 pregnancies included in the study, composite ANO occurred in 139 (13.2%). There were only two cases of early FGR (before 32 weeks); therefore, the study focused on late FGR. Our current FGR diagnostic criterion of EFW < 10th percentile was not associated significantly with composite ANO (relative risk (RR), 1.1 (95% CI, 0.6-1.8)), while the Delphi FGR criteria were (RR, 2.0 (95% CI, 1.2-3.3)). Our current definition of FGR showed higher discriminatory ability in the prediction of a SGA neonate (AUC, 0.69 (95% CI, 0.65-0.73)) than did the Delphi definition (AUC, 0.64 (95% CI, 0.60-0.67)) (P = 0.001). The AUCs of both definitions were poor for the prediction of composite ANO, despite slightly improved performance using the Delphi consensus definition of FGR (AUC, 0.53 (95% CI, 0.50-0.55)) compared with that of our current definition (AUC, 0.50 (95% CI, 0.48-0.53)) (P = 0.02). CONCLUSION: The newly postulated criteria for defining FGR based on a Delphi procedure detects fewer cases of neonatal SGA than does our current definition of EFW < 10th percentile, but is associated with a slight improvement in predicting ANO. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

The effect of maternal haematocrit on offspring IQ at 4 and 7 years of age: a secondary analysis.

OBJECTIVE: To determine whether maternal haematocrit during pregnancy is associated with offspring IQ. DESIGN/SETTING/POPULATION: A secondary analysis of the Collaborative Perinatal Project, which enrolled women between 1959 and 1966 at 12 university hospitals in the United States. METHODS: We evaluated the relation between maternal haematocrit and IQ at 4 and 7 years of age. Linear and log-linear regression models were used to adjust for possible confounders. Marginal structural models with stabilised weights were used to account for selection bias due to children lost to follow up. MAIN OUTCOME MEASURES: Offspring IQ at 4 and 7 years of age. RESULTS: Of 35 959 patients, 1521 (4.2%) had moderate anaemia, 13 769 (38.3%) had mild anaemia, 18 227 (50.7%) had a normal haematocrit, and 2442 (6.8%) had a high haematocrit. The mean IQ at 4 and 7 years was significantly lower in the moderate and mild anaemia groups than in the normal haematocrit group (92.3 and 94.7 versus 100.6, respectively, P < 0.01, at 4 years; and 90.2 and 93.4 versus 99.1 at 7 years, P < 0.01). The high haematocrit group had a significantly higher mean IQ (104.5 at 4 years; 103.2 at 7 years) when compared with the normal haematocrit group (P < 0.01). Women with moderate anaemia were more likely to have children with IQ of 70-84 at 4 years (RR 1.22, 95% CI 1.08-1.38) and <70 at 7 years (RR 1.59, 95% CI 1.14-2.23). Women with a high haematocrit were more likely to have children with an IQ ≥120 at 7 years (RR 1.22, 95% CI 1.08-1.39). CONCLUSIONS: Maternal haematocrit is associated with offspring IQ at 4 and 7 years of age. TWEETABLE ABSTRACT: There is a nonlinear relation between maternal haematocrit and offspring IQ at 4 and 7 years of age.

Prolonged latency of preterm prelabour rupture of membranes and neurodevelopmental outcomes: a secondary analysis.

OBJECTIVE: To determine whether prolonged latency after preterm prelabour rupture of membranes (PPROM) is associated with an increased risk for adverse neurodevelopmental outcomes. DESIGN: This is a secondary analysis of the randomised controlled trial of magnesium sulphate for the prevention of cerebral palsy. SETTING: Multicentre trial. POPULATION: A total of 1305 women with PPROM were analysed, 1056 of whom had an interval of <3 weeks between diagnosis and delivery and 249 of whom had an interval of ≥3 weeks between diagnosis and delivery. METHODS: We evaluated whether the time interval between diagnosis of PPROM and delivery was associated with an increased risk for adverse neurodevelopmental outcomes. Latency was analysed as a continuous variable and categorised by weeks of latency. MAIN OUTCOME MEASURES: The primary outcome was motor and mental Bayley scores of <70 at 2 years of age. Secondary outcomes included motor and mental Bayley scores <85 and mean Bayley scores. Logistic regression was used to control for confounding factors. RESULTS: In the univariate analysis, motor and mental Bayley scores of <70 were similar in the <3 weeks (16.8 and 14.4%) and ≥3 weeks (15.3 and 14.1%) groups. In the regression analysis adjusting for confounding factors, PPROM for ≥3 weeks was an independent risk factor for motor (adjusted odds ratio (aOR) 2.12; 95% confidence interval, 95% CI 1.29-3.49) and mental (aOR 1.83, 95% CI 1.13-3.00) Bayley scores of <70. Neonatal sepsis, gestational age at delivery, maternal education, and race were significantly associated with neurodevelopmental outcomes. CONCLUSIONS: Whereas delivery at later gestational age is associated with improved prognosis for many outcomes, prolonged exposure to an intrauterine environment of PPROM is an independent risk factor for adverse neurodevelopmental outcomes. TWEETABLE ABSTRACT: Prolonged PPROM was associated with motor and mental Bayley scores of <70.