Oral Plenary Session 1
Oral Plenary Sessions
Aaron W. Roberts, MD
Assistant Professor, Maternal Fetal Medicine
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Mar Romero-Lopez
McGovern Medical School at UTHealth
Houston, Texas, United States
John W. Hotra, BSc
Research Coordinator II
McGovern Medical School at UTHealth
Houston, Texas, United States
Eleazar E. Soto, MD
Assistant Professor
University of Texas Health Science Center in Houston, McGovern Medical School
Houston, Texas, United States
Angela Glaser
UT Houston
Houston, Texas, United States
Robyn Garcia
McGovern Medical School at UTHealth
Houston, Texas, United States
Jennie Coselli, MD
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth
Houston, Texas, United States
Suneet P. Chauhan, MD
Director of MFM Research
Delaware Center for Maternal-Fetal Medicine of Christiana Care
Newark, Delaware, United States
Hector Mendez-Figueroa, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
SMFM and ISUOG recommend antenatal surveillance (ANS) for fetal growth restriction (FGR), albeit with differing management algorithms. Our primary objective was to compare a composite neonatal adverse outcome (CNAO) among FGR utilizing SMFM vs. ISUOG-recommended ANS. The secondary objective was to compare composite maternal adverse outcomes (CMAO).
Study Design:
Our multi-center pre- and post-intervention study (NCT05938829), conducted over 2.5 years, included singleton non-anomalous FGR (EFW/AC < 10% for GA using Hadlock et al curve). The first group was managed via SMFM-recommended ANS (EFW, NST, and UA S/D ratio). The second group was managed according to ISUOG ANS (EFW, NST, UA PI index, MCA, and DV Dopplers). Delivery timing guidelines were congruent with recommendations from the evaluated ANS. Using Bayesian statistics, a sample size of 550 in each arm was estimated to detect a 1/3 decrease in the baseline 5% rate for CNAO, with >65% probability of any risk difference ( >80% power; possible effect sizes from 1000 simulated posterior distributions). Posterior probability of risk reduction (PPRR), posterior relative risk (pRR), 95% credibility intervals (CrI), and number needed to treat (NNT), or harm (NNH) were calculated.
Results:
Between the groups, maternal characteristics differed by race and ethnicity but otherwise were similar. Most deliveries occurred ≥34 weeks (88.4% SMFM, 91.5% ISUOG). (Table 1). The primary outcome occurred in 38 of 689 (5.5%) individuals during the SMFM guideline and 45 of 683 (6.6%) with ISUOG, resulting in a 27% PPRR for CNAO in the ISUOG group (pRR 1.19, 95% CrI 0.76-1.83). Compared to SMFM, ISUOG guidelines produced a NNH of 91 of increasing CNAO (95% CI 71-125). CMAO occurred in 9.1% during SMFM and 8.3% in ISUOG, a 73% PPRR (pRR 0.90, 95% CrI 0.61-1.31). The NNT to reduce CMAO was 125 (95% CI 80-279; Table 2).
Conclusion:
Among a diverse, low and high-risk FGR cohort, the use of ISUOG guidelines failed to decrease adverse neonatal outcomes compared to SMFM (6.6% vs 5.5%), with 73% posterior probability of harm.