{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T12:10:59Z","timestamp":1785499859372,"version":"3.56.0"},"reference-count":41,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,11,22]],"date-time":"2018-11-22T00:00:00Z","timestamp":1542844800000},"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":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Although early and late fetal growth restriction have been suggested to be distinct entities, the optimal gestational age cut\u2010off that differentiates the two conditions is currently unclear and has been arbitrarily set in previous studies between 32 and 37\u00a0weeks. We aimed to use placental pathology findings to determine that optimal gestational age cut\u2010off between early and late fetal growth restriction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A retrospective cohort study of all women with singleton gestation who gave birth to a neonate diagnosed as small\u2010for\u2010gestational age (small\u2010for\u2010gestational age, defined as birthweight &lt;10th percentile for gestational age) at a tertiary referral center between January 2001 and December 2015, and for whom placental pathology was available. Placental abnormalities were classified into lesions associated with maternal vascular malperfusion (<jats:styled-content style=\"fixed-case\">MVM<\/jats:styled-content>), fetal vascular malperfusion, placental hemorrhage and chronic villitis. Placental findings were analyzed as a function of gestational age at birth. The analysis was repeated in the subgroups of women without hypertensive complications of pregnancy (to reflect changes associated with isolated small\u2010for\u2010gestational age) and of neonates with severe small\u2010for\u2010gestational age (defined as birthweight &lt;5th percentile), which are more likely to represent true fetal growth restriction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 895 women met the inclusion criteria. The only histological finding that changed with gestational age was <jats:styled-content style=\"fixed-case\">MVM<\/jats:styled-content> pathology, which decreased in frequency with increasing gestational age. We identified a considerable drop in the rate of <jats:styled-content style=\"fixed-case\">MVM<\/jats:styled-content> lesions at 33\u00a0weeks of gestation. The rate of <jats:styled-content style=\"fixed-case\">MVM<\/jats:styled-content> pathology in placentas of infants born before 33<jats:sup>0\/7<\/jats:sup>\u00a0weeks was significantly higher than that observed in placentas of infants born at 33<jats:sup>0\/7<\/jats:sup>\u00a0weeks or longer: 71.6% vs 27.4%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001 for \u22652 <jats:styled-content style=\"fixed-case\">MVM<\/jats:styled-content> lesions, and 35.5% vs 3.5%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001 for \u22653 <jats:styled-content style=\"fixed-case\">MVM<\/jats:styled-content> lesions. These findings persisted in the subgroups of women without hypertensive complications of pregnancy (n\u00a0=\u00a0662) and of neonates with severe small\u2010for\u2010gestational age (n\u00a0=\u00a0464).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Using placental pathology as a direct measure of the mechanisms underlying fetal growth restriction, the optimal gestational age at birth cut\u2010off which differentiates early from late fetal growth restriction appears to be 33<jats:sup>0\/7<\/jats:sup>\u00a0weeks.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13499","type":"journal-article","created":{"date-parts":[[2018,10,29]],"date-time":"2018-10-29T19:24:10Z","timestamp":1540841050000},"page":"365-373","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Defining early vs late fetal growth restriction by placental pathology"],"prefix":"10.1111","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2741-3679","authenticated-orcid":false,"given":"Amir","family":"Aviram","sequence":"first","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Department of Obstetrics and Gynecology Sunnybrook Health Sciences Center University of Toronto Toronto Ontario Canada"},{"name":"The Sackler Faculty of Medicine Tel\u2010Aviv University Tel\u2010Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Sherman","sequence":"additional","affiliation":[{"name":"Division of Anatomic Pathology Department of Laboratory Medicine and Molecular Diagnostics Sunnybrook Health Sciences Center  University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kingdom","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Department of Obstetrics and Gynecology Mount Sinai Hospital University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Zaltz","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Department of Obstetrics and Gynecology Sunnybrook Health Sciences Center University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Barrett","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Department of Obstetrics and Gynecology Sunnybrook Health Sciences Center University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Melamed","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Department of Obstetrics and Gynecology Sunnybrook Health Sciences Center University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2017.11.004"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.11.566"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2004.02.009"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1159\/000353633"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01827.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCO.0000000000000051"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000429658.85846.f9"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(15)30865-3"},{"key":"e_1_2_9_10_1","unstructured":"Royal College of Obstetricians and Gynaecologists.The Investigation and Mangement of the Small-for-Gestational-Age Fetus. 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