Sozialepidemiologische, versorgungsbezogene und forschungsmethodische Aspekte der intrauterinen Wachstumsverzögerung (IUGR) des Fetus

Abstract

Fetal growth monitoring and an early antenatal detection of intrauterine growth restriction (IUGR) is of core importance in routine antenatal care. IUGR is associated with a higher risk for perinatal morbidity and mortality, and an elevated risk for chronic conditions later in life. Under routine conditions, low antenatal detection rates of 25 - 30 % were observed and there is a lack of a clearly defined terminology and definition of IUGR. Women with migrant background and low socioeconomic status may be specific groups having a higher chance of antenatal non-detection of IUGR. The primary objective of this dissertation is the examination of the routine antenatal care of women with pregnancies affected by suboptimal fetal growth, particularly with respect to health inequity and research-methodological aspects. Primary data of the project, entitled Care-related factors associated with antenatal diagnosis of intrauterine growth restrictions (IUGR) a a case-control study was used for this dissertation. The project had two components: (1) hospital-based case-control study with mothers of newborns with a birthweight 10th percentile and (2) a physician survey among gynecologists in Bremen and Lower Saxony. In our study suboptimal fetal growth was antenatally identified in less than half (47.8 %) of the cases as determined perinatally. A lesser degree of severity of IUGR, the absence of maternal complications / diseases during pregnancy, and no Doppler examination during the course of pregnancy were associated with a higher chance of antenatal non-detection of IUGR. Although not statistically significant, we found that antenatal non-detection of IUGR was about two times more likely in women with migration background (OR 1.8; 95 %a KI: 0.68, 4.56) as compared to non-migrants. The physician survey among primary care gynecologists indicates considerable variation in antenatal detection and management of (suspected) IUGR, e.g. in the use of cut-off values to classify a fetus as SGA. The results of these investigations indicate that there is a substantial potential for improvement in routine antenatal care in Germany. Better antenatal detection of IUGR may be aided by the establishment and implementation of a standardized terminology and definition of IUGR and (to the extent possible) the determination of an evidence-based management of (suspected) suboptimal fetal growth. One conceivable option is the implementation of a mandatory Doppler examination shortly before birth, in general or at least for some subgroups (e.g. women with migration background). Further research (with lager study populations) is needed to examine whether women with migration background or low socioeconomic status have a higher chance of antenatal non-detection of IUGR and to further investigate possible causal factors.