Outcomes Better Than Previously Reported for Babies With Poor Fetal Growth

In pregnancies complicated by poor fetal growth, infants experienced better outcomes than those historically reported, according to preliminary results of the Trial of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE). In fact, the study findings indicated that only 8% of babies died, and 70% survived without morbidity.

“Managing babies with growth restriction is particularly difficult to manage as there is real variation in counseling women about the outcome and deciding when to deliver these babies,” said study author Christoph Lees, MD, of Queen Charlotte’s & Chelsea Hospital, London.

TRUFFLE was a prospective, multicenter management study that enrolled 503 women with a single fetus at 26 to 32 weeks of gestation. The study was performed at 20 centers and enrolled women between 2005 and 2010.

Women were randomly assigned to 1 of 3 groups. In one group, the timing of delivery was based on monitoring the baby’s heart rate. In the other two groups, timing was based on changes in the Doppler ultrasound measurement of one of the baby’s blood vessels. A standardized prenatal monitoring and delivery protocol was used for all women in the trial.

The TRUFFLE study was designed to find out more information about perinatal morbidity and mortality after early-onset fetal growth restriction.

Overall, antenatal fetal death occurred in 2.4% of patients and 490 infants were live born. An additional 27 infants (5.5%) died during the initial neonatal admission.

Severe morbidity occurred in 24% of babies, for an overall rate of 31% of babies meeting the criteria for the composite outcome of death or severe morbidity. These babies had lower birth weights and were born earlier than other babies included in the study.

“Death and severe morbidity were significantly related to gestational age, both at study entry and delivery and also with the presence of maternal hypertensive morbidity,” the researchers wrote.

The median time from inclusion to delivery was 13 days in women without hypertensive morbidity compared with 5 days in women with gestational hypertensive morbidity. Specifically, the median time to delivery was 8 days for women with gestational hypertension, 4 days for preeclampsia, and 3 days for HELLP syndrome (characterized by hemolysis, elevated liver enzyme levels, and low platelet count).

Dr. Lees noted that the 2-year outcomes of the babies in the study will be available in 2014, which may provide clues about what management and monitoring strategy is best to optimize long-term neurodevelopmental outcome.

Pertinent Points:
- Decision-making about whether to deliver a very preterm growth-restricted baby has an outlook that is more optimistic than previously thought.
- Data on 2-year development outcomes are awaited.

References:

Lees C, Marlow N, Arabin B, et al. Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE). Ultrasound Obstet Gynecol. 2013;42:400-408.