Early Growth-Restricted Foetuses Face Multiple Challenges – Medscape

Report on Perinatal Outcomes of Early-Onset Foetal Growth Restriction and Implications for Sustainable Development Goals

1.0 Executive Summary

A recent systematic review and meta-analysis highlights the severe adverse outcomes associated with extremely early-onset foetal growth restriction (FGR), diagnosed at or before 26 weeks of gestation. The findings underscore significant challenges to achieving key health-related Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). The high rates of perinatal mortality, maternal complications, and long-term infant morbidity detailed in the study necessitate targeted healthcare interventions to advance global health targets.

2.0 Background and Methodology

The analysis synthesized data from 14 studies, encompassing 2,818 singleton pregnancies complicated by extremely early-onset FGR. The primary objective was to quantify perinatal and maternal outcomes, with a primary focus on perinatal death. This research provides critical data for evaluating progress towards global health initiatives and identifying areas requiring urgent attention.

3.0 Findings in the Context of SDG 3: Good Health and Well-being

The study’s results reveal a direct conflict with the ambitions of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

3.1 Challenges to SDG Target 3.2: End Preventable Newborn and Child Deaths

The goal to end preventable deaths of newborns is severely challenged by the high mortality rates associated with this condition. Key statistics include:

• Perinatal Death: Occurred in 16.0% of cases.
• Intrauterine Death: Accounted for 8.8% of cases.
• Neonatal Death: Occurred in 6.2% of cases.

These figures represent a significant loss of life that directly impedes progress on reducing neonatal mortality.

3.2 Implications for SDG Target 3.1: Reduce Maternal Mortality

Maternal health is also significantly impacted, posing risks that contravene the goal of reducing the global maternal mortality ratio.

• Preeclampsia: A life-threatening condition that affected 21.6% of the mothers in the cohort.
• Caesarean Section: Required in 45.6% of deliveries, a major surgery associated with short- and long-term maternal morbidity.

3.3 Impact on Long-Term Child Health and Well-being

For surviving infants, the risk of lifelong health challenges is high, affecting the broader SDG 3 objective of ensuring healthy lives.

1. Congenital Anomalies: Genetic and structural anomalies were identified in 9.6% and 23.2% of foetuses, respectively.
2. Prematurity: Preterm birth before 32 weeks occurred in 54.6% of pregnancies, a leading cause of long-term disability.
3. Adverse Perinatal Outcomes: A composite of adverse outcomes, including morbidity and NICU admission, was reported in 30.5% of infants.
4. Morbidity: Significant rates of neurologic morbidity (38.3%) and respiratory distress syndrome (21.7%) were observed.

While 61.8% of infants had intact survival, the high incidence of morbidity underscores the substantial burden of care required, impacting families and healthcare systems.

4.0 Broader Implications for Sustainable Development

4.1 SDG 5: Gender Equality

The findings reinforce the importance of SDG Target 5.6 (ensure universal access to sexual and reproductive health). Effective management of early-onset FGR requires that women are counselled on the significant risks to both their own health and the foetus. This empowers them with the necessary information for shared decision-making in their reproductive healthcare.

4.2 SDG 10: Reduced Inequalities

The diagnosis and management of complex conditions like FGR require advanced antenatal surveillance and neonatal care. Disparities in access to such specialised services can exacerbate health inequalities between and within countries, undermining SDG Target 10.2 (promote universal social, economic, and political inclusion).

5.0 Conclusion and Recommendations

Extremely early-onset FGR presents a formidable challenge to maternal and child health, directly impacting the achievement of SDG 3. The high rates of mortality and morbidity necessitate a focused global health response.

Based on the study’s limitations, which include heterogeneity and a lack of standardised protocols, the following is recommended:

• Development of standardised international criteria for the surveillance and timing of delivery in pregnancies affected by early-onset FGR.
• Investment in research to improve prediction, prevention, and management strategies.
• Strengthening healthcare systems to ensure equitable access to high-quality antenatal and neonatal care, in line with SDG Target 3.8 (achieve universal health coverage).

Addressing the outcomes of early-onset FGR is not merely a clinical issue but a developmental imperative for advancing global health and well-being.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article is fundamentally centered on health outcomes, specifically maternal and child health. It discusses severe complications during pregnancy (foetal growth restriction, preeclampsia), high rates of perinatal and neonatal death, and significant infant morbidity (neurologic and respiratory issues). These topics directly align with SDG 3’s objective to ensure healthy lives and promote well-being for all at all ages, with a particular focus on reducing maternal and child mortality.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

  This target is relevant because the article highlights conditions that significantly increase the risk of maternal morbidity and mortality. The high incidence of preeclampsia (affecting 21.6% of pregnancies) and the high rate of caesarean sections (45.6%) are major risk factors for maternal health complications. The article’s recommendation to counsel women on “short- and long-term maternal morbidity” underscores the connection to maternal health and safety.

• Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age.

  This is the most directly addressed target. The study’s primary outcome was perinatal death, which occurred in 16.0% of cases. The article explicitly breaks this down into intrauterine death (8.8%) and neonatal death (6.2%). The high rate of preterm births (54.6% before 32 weeks) is a leading cause of neonatal mortality and morbidity, which is a core concern of this target. The discussion of adverse perinatal outcomes, including NICU admission and conditions like respiratory distress syndrome, further connects the article’s findings to the goal of ensuring child survival and well-being.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicators for Target 3.1 (Maternal Health)

  While the article does not mention the official Maternal Mortality Ratio, it provides several proxy indicators that measure maternal health risks and outcomes:

  • Incidence of preeclampsia: The article states that preeclampsia affected 21.6% of the pregnancies studied, serving as a direct indicator of a life-threatening maternal health complication.
  • Proportion of births by caesarean section: The rate of 45.6% is a significant indicator, as caesarean sections, especially in a high-risk context, are associated with increased maternal morbidity.

• Indicators for Target 3.2 (Newborn and Child Health)

  The article provides direct data that can be used as indicators to measure progress toward reducing newborn mortality and morbidity:

  • Perinatal death rate: The overall rate was 16.0%.
  • Neonatal death rate: The rate was 6.2% (or 62 per 1,000), which is a direct measure related to the official Neonatal Mortality Rate indicator.
  • Preterm birth rate: The article specifies that 54.6% of births occurred before 32 weeks of gestation, a key indicator for neonatal risk.
  • Infant morbidity rates: The article provides specific rates for adverse outcomes, such as respiratory distress syndrome (21.7%) and neurologic morbidity (38.3%), which are crucial indicators for assessing the health and well-being of surviving infants.

4. Table of SDGs, Targets, and Indicators

Source: medscape.com