Reproductive experience and risk of growth restriction or small for gestational age fetus

Introduction. The problem of birth of a fetus of insufficient growth – with fetal growth restriction (FGR) or small for gestational age (SGA) – is relevant all over the world and subject to different pathogenesis pathways. Maternal reproductive experience is considered as a key risk factor for FGR or SGA, nevertheless, leaves questions unanswered.

Aim. Stratify risk groups for FGR or SGA based on reproductive history factors.

Materials and methods. A retro-prospective analytical study carried out. Period – 2016–2021. Adolescent girls and women of reproductive age with completed pregnancies included. A prospective cohort study carried out. Study period – 2018–2023. 611 women with insufficient fetal growth (IFG) were included, divided into two groups: with FGR (n = 435) and with SGA (n = 176).

Results and discussion. In the structure of reproductive losses of patients with IFG, non-progressive pregnancy (NPP) dominates. FGR differs from SGA by: the upcoming first pregnancy (OR = 6.63) or first birth (OR = 3.99); reproductive losses (OR = 1.49 (total), NPP (OR = 2.83), ectopic pregnancy EP (p = 0.01) and spontaneous abortion (SA) (p = 0.007); shorter interval from previous pregnancy (p < 0.001) or birth (p = 0.049) to current pregnancy; higher number of SA (p = 0.006) and artificial abortions (AA) (p = 0.03); shorter period of reproductive losses (p < 0.001); lower number of births (p < 0.001); earlier term of delivery (p < 0.001) and low birth weight (p < 0.001); exclusive association with assisted reproductive technologies (p < 0.001). EP and SA are exclusive markers of FGR, AA are more typical for SGA (OR = 2.13). 44.52% of women with IFG have experience of childbirth, 60.29% of them by cesarean section (CS), most of all among women with FGR (OR = 1.68). Only women with FGR had experience of premature birth (21.84%) and delivery of a low-weight fetus, exclusively in case of prematurity. The hierarchy of the relationship between multifactorial reproductive history and the variant of IFG was confirmed using decision trees (classification and regression).

Conclusion. Patients with IFG have no reproductive experience in 44.19%, and its presence is specific, in 31.42% it is burdened with reproductive losses. FGR differs from SGA in a more burdened reproductive history, which represents it as a marker of reproductive dysfunction. There is a hierarchy of relationships between reproductive history factors and the variant of IFG, which allows forming risk groups at the pregestational stage and early pregnancy, adapting diagnostic and preventive measures to them.

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