(471) The Impact of Maternal Comorbidities on Neonatal Outcomes in Growth Restricted Fetuses

Thursday, January 30, 2025

4:00 PM - 6:00 PM

Submitting Author and Presenting Author(s)

Dhara Kadakia, MA, MD

Icahn School of Medicine at Mount Sinai West
New York, New York, United States

Coauthor(s)

Olivia Grubman, MD

MFM Attending
Westchester Medical Center
Westchester, NY, United States
HN

Hajer Naveed, BA

Medical Student
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Mia A. Heiligenstein, MD

Fellow
Mount Sinai West
Astoria, NY, United States
Thomas Owens, MD

Dr Thomas Owens
Icahn School of Medicine at Mount Sinai West
New York, New York, United States
GS

Guillaume Stoffels, MS

Statistician
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Nathan S. Fox, MD

Clinical Professor
Icahn School of Medicine at Mount Sinai Hospital
New York, New York, United States
ZA

Zainab Al-Ibraheemi, MD

Icahn School of Medicine at Mount Sinai West
New York, New York, United States
LB

Lois Brustman, MD

Icahn School of Medicine at Mount Sinai West
New York, New York, United States

Objective: To determine the impact on neonatal outcomes in fetal growth restricted fetuses (FGR) in patients with and without medical comorbidities.

Study Design: A retrospective cohort study performed on singleton gestations from 2018-2022.Patients included had FGR at the last scan prior to delivery. A composite of maternal comorbidities included: chronic hypertension(cHTN), pregestational diabetes(DM), connective tissue disease(CT), IVF, IBD, thrombophilia and maternal age >40. A sub-group of comorbidities with a vascular component (DM,cHTN,CT) was reviewed. FGR was divided into 3 groups: Mild(mFGR): EFW >10% with AC< 10%, Moderate (MFGR):EFW 3rd-10%, Severe (sFGR):EFW< 3rd%.The primary outcome was a neonatal composite: NICU Admission,APGAR < 5 at 5 minutes,and hypoglycemia. Logistic regressions were used to examine the relationship between maternal comorbidities,timing of FGR diagnosis,and neonatal outcomes.

Results: Total patients were 534: 297 mFGR,184 MFGR, and 53 with sFGR. Of 534 patients,105(19.7%) had comorbidities (of these 48 had vascular comorbidities); 429 had no comorbidities. 127(23.8%) of 534 had an adverse neonatal outcome. Adverse outcomes increased significantly with severity of FGR:15.8% in mFGR; 26.6% in MFGR;58.5% in sFGR. In a univariable analysis, cHTN,AMA,early FGR diagnosis,and FGR severity were significantly associated with an increased risk of adverse outcomes (Table 1).The odds of an adverse outcome were 2.17 times more in those with any comorbidity compared to those without comorbidities(OR 2.17,95% CI 1.37-3.4).When a vascular comorbidity was present, an adverse outcome was 4.50 times more likely compared to those with no comorbidities(OR 4.5,95% CI 2.45-8.28).The presence of a vascular comorbidity < 32wks had a significant association with an adverse neonatal outcome in all severities of FGR (Table 2).

Conclusion: In the setting of FGR, the presence of maternal medical comorbidities, particularly vascular, had significantly increased risk of adverse neonatal outcomes.These findings could help us better counsel patients in regards to antepartum testing and patients' expectations.