Role of maternal risk factors in foetal growth impairment

INTRODUCTION: Clinical goal of foetal growth evaluation is primarily to identify foetuses with an accelerated or decelerated growth rate. Chief criterion of normal intrauterine development is a timely delivery of a neonate meeting applicable health norms. Obstetrician's decisions on how a pregnancy should be handled are based on foetal development and growth forecast and take into account whether foetal growth is normal, accelerated or decelerated. Such assessment requires correct determination of foetal age, selection of the most appropriate growth rate standards and defining potential risk factors. The aim of this study was to evaluate the impact of pre-selected risk factors on foetal growth. Material was 3889 foetuses (2203 males and 1686 females) stillborn between 20th and 42nd week of pregnancy. Morphological development of the study material was characterised based upon the values of seven pre-defined somatic features and the weight of eight internal organs. Clinical classification of maternal risk factors revealed four factors of most potent impact on foetal development, ie. maternal age, number of pregnancy and artificial and natural miscarriage history. RESULTS: Verification of developmental status of foetuses, ie. exposed vs. non-exposed to risk factors, allowed to determine the potency of selected risk factors. The non-exposed group was characterised by normal growth rate during each of stage of development meaning that despite being stillborn these foetuses did not differ significantly in their development of the selected features from live born foetuses. In the exposed group, however, the rate of development, compared to the standard, was significantly reduced and starting from the 35th week it was below the 5th percentile. It can, therefore, be seen that the exposed group development was significantly influenced by an adverse impact of risk factors. CONCLUSIONS: Our results show that the risk factors for the exposed group are a group of maternal risk factors impairing foetal growth and leading to hypotrophy. The abnormalities induced by the environmental risk factors did not, however, lead to foetal death. Neither risk factors, nor the potency of their impact were the causes of deaths of the analysed foetuses.