RESEARCH

Fetal growth in early pregnancy and risk of delivering low birth weight infant: prospective cohort study

¹ Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
² Department of Obstetrics and Gynaecology, Cambridge University, Cambridge CB2 2SW
³ Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin 1, Ireland
⁴ University of California San Francisco, San Francisco, CA 94143-013, USA
⁵ Fetal and Women's Center of Arizona, Scottsdale, AZ 85258, USA
⁶ William Beaumont Hospital, Royal Oak, MI 48073, USA
⁷ Department of Obstetrics and Gynaecology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
⁸ Albert Einstein College of Medicine, Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461
⁹ University of Colorado Health Sciences Center, Denver, CO 80262, USA
¹⁰ Tufts University School of Medicine, Boston, MA 02111, USA
¹¹ Division of Ob/Gyn Ultrasound, New York University School of Medicine, New York, NY 10016-9196
¹² Brown University School of Medicine, Providence, RI 02905, USA
¹³ University of North Carolina Medical Center, University of North Carolina, Chapel Hill, NC 27599, USA

^* Correspondence to: rkbukows{at}utmb.edu.

Objective To determine if first trimester fetal growth is associated with birth weight, duration of pregnancy, and the risk of delivering a small for gestational age infant.

Design Prospective cohort study of 38 033 pregnancies between 1999 and 2003.

Setting 15 centres representing major regions of the United States.

Participants 976 women from the original cohort who conceived as the result of assisted reproductive technology, had a first trimester ultrasound measurement of fetal crown-rump length, and delivered live singleton infants without evidence of chromosomal or congenital abnormalities. First trimester growth was expressed as the difference between the observed and expected size of the fetus, expressed as equivalence to days of gestational age.

Main outcome measures Birth weight, duration of pregnancy, and risk of delivering a small for gestational age infant.

Results For each one day increase in the observed size of the fetus, birth weight increased by 28.2 (95% confidence interval 14.6 to 41.2) g. The association was substantially attenuated by adjustment for duration of pregnancy (adjusted coefficient 17.1 (6.6 to 27.5) g). Further adjustments for maternal characteristics and complications of pregnancy did not have a significant effect. The risk of delivering a small for gestational age infant decreased with increasing size in the first trimester (odds ratio for a one day increase 0.87, 0.81 to 0.94). The association was not materially affected by adjustment for maternal characteristics or complications of pregnancy.

Conclusion Variation in birth weight may be determined, at least in part, by fetal growth in the first 12 weeks after conception through effects on timing of delivery and fetal growth velocity.