{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T14:57:37Z","timestamp":1782572257418,"version":"3.54.5"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>We have shown previously that third\u2010trimester growth in small fetuses (estimated fetal weight (EFW) &lt;\u200910<jats:sup>th<\/jats:sup> percentile) with birth weight (BW) &lt;\u200910<jats:sup>th<\/jats:sup> percentile is heterogeneous using individualized growth assessment (IGA). We aimed to test our hypothesis that individual growth patterns in small fetuses with BW &gt;\u200910<jats:sup>th<\/jats:sup> percentile are also variable but in different ways.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a study of 191 cases with EFW &lt;\u200910<jats:sup>th<\/jats:sup> percentile and BW &gt;\u200910<jats:sup>th<\/jats:sup> percentile (appropriate\u2010for\u2010gestational\u2010age (AGA) cohort), derived from the PORTO study. Composite size parameters were used to quantify growth pathology at individual third\u2010trimester timepoints (individual composite prenatal growth assessment score (\u2212icPGAS)). The fetal growth pathology score 1 (\u2212FGPS1), calculated cumulatively from serial \u2212icPGAS values, was used to characterize third\u2010trimester growth patterns. Vascular\u2010system evaluation included umbilical artery (UA) and middle cerebral artery (MCA) Doppler velocimetry. Outcome variables were birth age (preterm\/term delivery) and BW (expressed as growth potential realization index for weight (GPRI<jats:sub>WT<\/jats:sub>) and percentile). The findings from the AGA cohort were compared with those from small fetuses (EFW &lt;\u200910<jats:sup>th<\/jats:sup> percentile) with BW &lt;\u200910<jats:sup>th<\/jats:sup> percentile (small\u2010for\u2010gestational\u2010age (SGA) cohort).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The AGA cohort was found to have 134 fetuses (70%) with normal growth pattern and 57 (30%) with growth restriction based on IGA criteria. Seven growth\u2010restriction \u2212FGPS1 patterns were observed, including the previously defined progressive, late, adaptive and recovering types. The recovering type was the most common growth pattern in the AGA cohort (50.9%). About one\u2010third of fetuses without any evidence of growth restriction had significant unexplained abnormalities in the UA (34%) and MCA (31%) and elevated mean GPRI<jats:sub>WT<\/jats:sub> values (113\u2009\u00b1\u200912.5%). Comparison of the AGA and SGA cohorts indicated a significant difference in the distribution of \u2212FGPS1 growth patterns (<jats:italic>P<\/jats:italic>\u2009=\u20090.0001). Compared with the SGA cohort, the AGA cohort had more fetuses with a normal growth pattern (70% <jats:italic>vs<\/jats:italic> 38%) and fewer cases with growth restriction (30% <jats:italic>vs<\/jats:italic> 62%). While the recovering type was the most common growth\u2010restriction pattern in the AGA cohort (51%), the progressive type was the primary growth\u2010restriction pattern in the SGA cohort (44%). No difference in the incidence of MCA or UA abnormality was found between the SGA and AGA cohorts when comparing subgroups of more than 10 fetuses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Both normal\u2010growth and growth\u2010restriction patterns were observed in the AGA cohort using IGA, as seen previously in the SGA cohort. The seven types of growth restriction defined in the SGA cohort were also identified in AGA cases, but their distribution was significantly different. In one\u2010third of cases without evidence of growth pathology in the AGA cohort, Doppler abnormalities in the UA and MCA were seen. This heterogeneity underscores the difficulty of accurate classification of fetal and neonatal growth status using conventional population\u2010based methods. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23688","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T06:50:05Z","timestamp":1621234205000},"page":"882-891","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Third\u2010trimester growth diversity in small fetuses classified as appropriate\u2010for\u2010gestational age or small\u2010for\u2010gestational age at birth"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1522-160X","authenticated-orcid":false,"given":"R. L.","family":"Deter","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3516-6129","authenticated-orcid":false,"given":"W.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Dicker","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Royal College of Surgeons in Ireland, Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. C.","family":"Tully","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Royal College of Surgeons in Ireland, Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Cody","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Royal College of Surgeons in Ireland, Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. D.","family":"Malone","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Royal College of Surgeons in Ireland, Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. M.","family":"Flood","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Royal College of Surgeons in Ireland, Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12]]},"reference":[{"issue":"1","key":"e_1_2_8_2_1","first-page":"S16","article-title":"Birth weights and stillbirths in historical perspective","volume":"52","author":"Steckel RH","year":"1998","journal-title":"Eur J Clin Nutr"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(67)80066-0"},{"key":"e_1_2_8_4_1","first-page":"361","volume-title":"Ultrasound in Obstetrics and Gynecology","author":"Deter RL","year":"1993"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13148"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17211"},{"key":"e_1_2_8_7_1","first-page":"156","article-title":"Mathematical modeling of fetal growth: development of individual growth curve standards","volume":"68","author":"Deter RL","year":"1986","journal-title":"Obstet Gynecol"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.12.210"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1395849"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1300646"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1337741"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2019.1677592"},{"key":"e_1_2_8_13_1","first-page":"1","article-title":"Growth patterns and cardiovascular abnormalities in SGA fetuses: 2. 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