Is there overdiagnosis of fetal growth restriction (Fetal Growth Restriction, FGR) in the Hispanic population living in the United States (US)?

From the Guidelines

There is no evidence to suggest that fetal growth restriction (FGR) is systematically overdiagnosed in the Hispanic population living in the United States, and healthcare providers should prioritize accurate diagnosis using ethnicity-specific growth charts and comprehensive assessment 1.

Key Considerations

• Hispanic women in the US may face unique risk factors for true FGR, including disparities in prenatal care access, higher rates of certain medical conditions like gestational diabetes, and socioeconomic factors that can impact fetal growth.
• The use of inappropriate growth standards may lead to misclassification of normal Hispanic fetuses as growth-restricted, highlighting the importance of using ethnicity-specific growth charts 1.
• A comprehensive assessment for FGR should include serial ultrasound measurements, Doppler studies of placental and fetal circulation, and consideration of maternal risk factors, as outlined in the society for maternal-fetal medicine consult series #52 1.

Diagnostic Approach

• Clinicians should be aware that both overdiagnosis and underdiagnosis of FGR carry risks - overdiagnosis may lead to unnecessary interventions including early delivery, while underdiagnosis could miss truly growth-restricted fetuses at risk for adverse outcomes 1.
• The decision to deliver is typically guided by maternal factors, such as the presence of maternal hypertension, and by fetal comorbidities, such as the degree of growth restriction and the severity of abnormal fetal surveillance results 1.
• Accumulating evidence suggests a benefit to the use of umbilical artery Doppler in the surveillance of FGR, and the presence of a standardized protocol for diagnosis and management appears to be associated with more favorable outcomes 1.

Management and Outcomes

• Management of FGR is based on early diagnosis, optimal fetal surveillance, and timely delivery that reduces perinatal mortality and minimizes short- and long-term morbidity 1.
• The single most important prognostic factor in preterm fetuses with growth restriction is the gestational age at delivery, with an increase of 1%–2% in intact survival for every additional day spent in utero up until 32 weeks of gestation 1.

From the Research

Fetal Growth Restriction in the Hispanic Population Living in the US

• There is limited research specifically focusing on overdiagnosis of fetal growth restriction in the Hispanic population living in the US 2, 3, 4, 5, 6.
• Fetal growth restriction is a common complication of pregnancy associated with adverse perinatal outcomes, and its diagnosis and management can be challenging 4.
• The American College of Obstetricians and Gynecologists (ACOG) and other medical societies have published guidelines for the management of fetal growth restriction, including the use of aspirin for prevention in high-risk women 3, 4, 5.
• Aspirin has been shown to reduce the risk of preeclampsia and fetal growth restriction in high-risk women, with a dose-response effect observed when initiated at ≤16 weeks of gestation 6.
• However, the optimal dose and timing of aspirin initiation, as well as the management of fetal growth restriction, may vary depending on individual risk factors and guidelines from different medical societies 3, 5.
• Further research is needed to improve the identification of patients likely to benefit from prophylactic aspirin and to develop uniform international protocols for the early recognition, surveillance, and management of growth-restricted fetuses 5.
• The provided studies do not specifically address the issue of overdiagnosis of fetal growth restriction in the Hispanic population living in the US, and more research is needed to understand this topic.