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ObjectiveTo examine the validity of a growth trajectory method to discriminate between pathologically and constitutionally undergrown fetuses using repeated measures of estimated fetal weight.MethodsIn a prospective, observational, multicenter study in Ireland, 1,116 women with a growth-restricted fetus diagnosed participated with the objective of evaluating ultrasound findings as predictors of pediatric morbidity and mortality. Fetal growth trajectories were based on estimated fetal weight.ResultsBetween 22 weeks of gestation and term, two fetal growth trajectories were identified: normal (96.7%) and pathologic (3.3%). Compared with the normal trajectory, the pathologic trajectory was associated with an increased risk for preeclampsia (odds ratio [OR] 8.1, 95% confidence interval [CI] 2.6-23.4), increased umbilical artery resistance at 30 weeks of gestation (OR 12.6, 95% CI 4.6-34.1) or 34 weeks of gestation (OR 28.0, 95% CI 8.9-87.7), reduced middle cerebral artery resistance at 30 weeks of gestation (OR 0.33, 95% CI 0.12-0.96) or 34 weeks of gestation (OR 0.14, 95% CI 0.03-0.74), lower gestational age at delivery (mean 32.02 weeks of gestation compared with 38.02 weeks of gestation; PConclusionsFetal growth trajectory analysis reliably differentiated fetuses with a pathologic growth pattern among a group of women with growth-restricted fetuses. With further development, this approach could provide clarity to how we define, identify, and ultimately manage pathologic fetal growth.Level of evidenceII.

Original publication




Journal article


Obstetrics and gynecology

Publication Date





248 - 254


Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom; and the UCD Obstetrics and Gynecology, School of Medicine and Medical Science, National Maternity Hospital, University College Dublin, Royal College of Surgeons in Ireland, Coombe Women and Infants University Hospital, and Rotunda Hospital, Dublin, University College Cork, Cork University Maternity Hospital, Cork, Royal Jubilee Maternity Hospital, Belfast, National University of Ireland, Galway, and Graduate Entry Medical School, University of Limerick, Limerick; University College Dublin Center for Human Reproduction, Coombe Women and Infants University Hospital, Dublin; Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin; and School of Nursing and Midwifery, Queens University, Belfast, Ireland.


Humans, Fetal Growth Retardation, Ultrasonography, Prenatal, Prospective Studies, Pregnancy, Models, Biological, Adult, Female, Young Adult