Maternal factors and perinatal outcomes associated with early-onset versus late-onset fetal growth restriction: a meta-analysis

Abstract

Background Fetal growth restriction (FGR) is considered to be one of the most common causes of adverse perinatal outcomes. This study conducted a meta-analysis of the maternal factors and perinatal outcomes associated with early-onset FGR (EO-FGR) compared to late-onset FGR (LO-FGR).Methods Studies describing the maternal factors and/or perinatal outcomes in singleton pregnant women with ultrasound and Doppler-confirmed FGR published between 2014 and 2024 in Scopus, Web of Science, MEDLINE, and PubMed databases were systematically searched with protocol registered in PROSPERO (CRD42024588608). Results were expressed as odds ratio and mean differences with 95% confidence intervals or hazard ratios.Results 3825 pregnant women complicated with 1300 EO-FGR and 2525 LO-FGR from 14 studies were included. Pregnancies with preeclampsia were at higher risk of EO-FGR (OR 4.25, 95% CI 2.47-7.32, I2 = 77%), whereas pregnancies with EO-FGR were at higher risk of being delivered by cesarean section (OR 5.83, 95% CI 2.76-12.32, I2 = 98%). Severe perinatal outcomes were significantly higher in the EO-FGR, including APGAR <7 at 5 min (OR 6.35, 95% CI 2.98-13.56, I2 = 78), neonatal resuscitation (OR 6.11, 95% CI 3.08-12.12, I2 = 0), NICU admission (OR 13.38, 95% CI 3.70-48.33, I2 = 94), anemia (OR 117.68, 95% CI 3.23-4289.12, I2 = 76), jaundice (OR 6.39, 95% CI 2.98-13.69, I2 = 0), NEC (OR 12.77, 95% CI 3.00-54.40, I2 = 0), PVL (OR 7.59, 95% CI 1.30-44.28, I2 = 0), IVH (OR 5.09, 95% CI 2.19-11.82, I2 = 49), RDS (OR 7.08, 95% CI 1.55-32.39, I2 = 92), sepsis (OR 10.92, 95% CI 2.57-46.34, I2 = 0), and perinatal death (OR 10.01, 95% CI 5.76-17.39, I2 = 34).Conclusion Preeclampsia is significantly contributed as the maternal factor associated with a higher risk of EO-FGR. The risk of having a cesarean birth and severe perinatal outcomes are significantly higher in the EO-FGR.

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