{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T03:03:00Z","timestamp":1790391780844,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>International guidelines recommend genetic testing when fetal growth restriction (FGR) accompanies structural anomalies, but recommendations for apparently isolated FGR remain variable, particularly regarding gestational age thresholds and the role of exome sequencing (ES). Interpretation is difficult because studies define FGR inconsistently, applying differing severity thresholds and \u201cisolated\u201d criteria, producing wide variation in reported yields. Chromosomal microarray analysis (CMA) provides an incremental yield of approximately 3% over karyotyping in isolated FGR, with pathogenic or likely pathogenic findings of 0%\u20138.1% across defined isolated subgroups, compared with approximately 10% in FGR with structural anomalies. After non\u2010diagnostic CMA, ES yields pathogenic diagnoses in approximately 7%\u201318% of selected isolated cases and in over 30% of cohorts with structural anomalies. Fetal phenotype is the strongest predictor of ES yield, particularly in cases with disproportionately short long bones; the absence of clinical, Doppler, or biochemical evidence of placental insufficiency may indicate a higher genetic likelihood. Current ES data remain limited by small samples and heterogeneous definitions. The sFlt\u20101\/PlGF ratio may distinguish placental\u2010mediated from genetically determined growth restriction and refine selection for genomic testing, although this remains hypothesis\u2010generating. We propose a phenotype\u2010driven framework, applicable to singleton pregnancies, integrating sonographic phenotype, placental assessment, and prior screening to guide genetic testing in FGR.<\/jats:p>","DOI":"10.1002\/pd.70250","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:41:46Z","timestamp":1790390506000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Genetic Investigation in Fetal Growth Restriction: An Integrated Approach for Clinical Practice"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3016-6282","authenticated-orcid":false,"given":"Eran","family":"Ashwal","sequence":"first","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1944-7294","authenticated-orcid":false,"given":"David","family":"Chitayat","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The Prenatal Diagnosis and Medical Genetics Program University of Toronto  Toronto Ontario Canada"},{"name":"Division of Clinical and Metabolic Genetics, Department of Pediatrics The Hospital for SickKids University of Toronto  Toronto Ontario 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