Stillbirth Prevention and Severe SGA and LGA


New research finds that obstetricians may be overlooking an at-risk group for implementing stillbirth prevention strategies.

Abnormal fetal growth, including both small for gestational age (SGA) or large for gestational age (LGA), was associated with stillbirth, according to a study published in PLOS Medicine.

The link between stillbirth and either restricted or excessive fetal growth was most pronounced in the most extreme ends of growth, the researchers reported. 

Pertinent Points

- Researchers identified a link between abnormal fetus growth and stillbirth.

- Stillbirth was associated with both small for gestational age and large for gestational age. The association was most pronounced among fetuses at the extreme ends of growth.

- These findings could influence how clinicians focus on stillbirth prevention.

For the study, researchers from the University of Texas Medical Branch (UTMB) and the Stillbirth Collaborative Research Network evaluated 663 stillbirths and 1,932 live births that occurred over 2.5 years at 59 hospitals in 5 US regions. 

The findings suggest that, contrary to current practices, obstetricians should focus on identifying fetuses that fall into those two categories when offering stillbirth prevention strategies to pregnant women.

"We hope that the findings of this study will initiate a process leading to a new approach to prevention of stillbirth," said Radek Bukowski, MD, PhD, lead researcher and professor of obstetrics and gynecology at UTMB, in a news release.

By classifying 10% of pregnancies with abnormal growth, the authors estimated a potential to identify 44% to 46% of future stillbirths.

Overall, abnormal fetal growth was identified in 25% of stillbirths using population norms and in more than 50% of stillbirths that used ultrasound or individualized norms for determining gestational age.

Among fetuses identified as SGA, meaning the bottom 10% of the population weight for gestational age, there was a 3- to 4-fold increased risk of stillbirth compared with having a fetus with appropriate weight for gestational age, the authors reported. In fetuses determined to be LGA, or those in the top 10% of the population weight for gestational age, there was an increased risk of stillbirth based on the ultrasound and individualized norms but not based on the population norms, the study found.

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