Fetal growth restriction in rural Bangladesh: a prospective study.

Background: Fetal growth restriction (FGR) and low birth weight(LBW) are serious public health problems. In developing countries, the incidence of low birth weight is predominantly the result of FGR, and both low birth weight and FGR are associated with neonatal death and later growth and development. Fetal growth charts are important for assessing the size of the fetus during pregnancy. The aims of this study were to describe the fetal growth pattern of a population in rural Bangladesh where maternal undernutrition is prevalent and to compare the timing of FGR in that population with WHO and INTERGROWTH- 21st international reference values.

Methods: From November 2001 to October 2003, pregnant women were recruited in Matlab, a sub district of Bangladesh, and underwent three follow-up ultrasound examinations during pregnancy for measurement of the parameters of the fetal head, abdomen, and femur. The data were fitted to a linear-cubic model, and the derived values were compared with international reference values.

Results: A total of 2678 singleton pregnancies were included in the analyses. The mean (SD) maternal age was 25.9 (5.8) years (range, 14-47 years). The mean (SD) early pregnancy BMI was 20.1 (2.6) kg/m2 , and 27.6% of the women were underweight (BMI < 18.5 kg/m2 ). The growth of the biparietal diameter and abdominal circumference was significantly smaller throughout the pregnancy than the reference values ( P  ≤ 0.05). Moreover, a larger deviation in the growth of Bangladeshi fetuses was observed after 28 weeks of gestation when compared with the WHO and INTERGROWTH-21st reference fetal growth charts ( P  ≤ 0.05). After 28 weeks of gestation, the average Bangladesh estimated fetal weight gain per week of gestational age was significantly lower than the WHO estimated fetal weight by as much as 67.4 g ( P  ≤ 0.001).

Conclusions: The present population-based study showed that fetuses were smaller in the third trimester when compared with the reference charts. Growth faltering started in the second trimester for all the biometric parameters for the head, abdomen, and femur. This finding provides more challenges concerning nutritional interventions.