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Congenital Malformations and Intrauterine Growth Retardation: A Population Study
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1988
Year
FertilityDefectsFetal GrowthEmbryologyRelative Risk 25Congenital DisordersAbnormal DevelopmentPublic HealthCongenital MalformationsMaternal HealthPrenatal DiagnosisRelative Risk 46Child DevelopmentDevelopmental AnomalyDevelopmental BiologyDysplasiaPediatricsFetal ComplicationMedicineIntrauterine Growth Retardation
Malformations and intrauterine growth retardation may be linked because IUGR can be a secondary effect of malformations, a predisposing factor, or arise from shared etiologic causes. The study examined the association between congenital malformations and intrauterine growth retardation using data from the Metropolitan Atlanta Congenital Defects Program. Researchers identified 13,074 infants with major malformations born 1970–1984 and classified IUGR when birth weight fell below the race‑, sex‑, and gestational‑age‑specific tenth percentile. Intrauterine growth retardation occurred in 22.3% of malformed infants (RR 2.6); 46 of 48 defect categories showed excess IUGR, notably trisomy 18 (83.7%, RR 46) and anencephaly (73.3%, RR 25), and the rate rose from 20% with two defects to 60% with nine or more.
The relationship between congenital malformations and intrauterine growth retardation was investigated using data from the population-based Metropolitan Atlanta Congenital Defects Program. Between 1970 and 1984, the system ascertained 13,074 infants with major structural malformations diagnosed in the first year of life and born to metropolitan Atlanta residents. These infants were classified as having intrauterine growth retardation if their birth weight was below the race-, sex-, and gestational age-specific tenth percentile limits for all Atlanta births. Overall, the frequency of intrauterine growth retardation among malformed infants was 22.3% (relative risk 2.6). Of 48 defect categories evaluated, 46 were associated with excess intrauterine growth retardation, most notably chromosomal anomalies (eg, 83.7% for infants with trisomy 18, relative risk 46) and anencephaly (73.3%, relative risk 25). Only a few isolated defects (such as isolated polydactyly, pyloric stenosis, and congenital hip dislocation) were not associated with excess intrauterine growth retardation. Among infants with multiple malformations, the frequency of intrauterine growth retardation increased markedly with increasing number of defects--from 20% for infants with two defects to 60% for infants with nine or more defects. The relationship between malformations and intrauterine growth retardation can be explained by one or more of three mechanisms: (1) intrauterine growth retardation can be a secondary disturbance to the presence of malformations; (2) intrauterine growth retardation can predispose the fetus to malformations; and (3) intrauterine growth retardation can coexist with malformations because of common etiologic factors. (ABSTRACT TRUNCATED AT 250 WORDS)