N J Mamelle

Identification of newborn babies with fetal growth restriction remains a problem both from the multi-factorial aspect of fetal growth and from statistical definition. Besides the usual terms: ‘Small for gestational age’ (SGA) and intrauterine growth retardation (IUGR), often used synonymously, the term ‘fetal growth retardation’ was recently introduced in reference to the genetic growth potential of infants. From a sample of 72,000 births, we have designed a statistical model in order to estimate the expected birth weight taking into account gestational age, sex, birth rank, maternal age, height and pregravid weight, we then calculated an individual limit of birth weight under that a newborn must be considered as having a ‘fetal growth restriction’ quoted FwGR. This new approach allowed us to identify 2 groups of newborns with FGR, one classically identified as SGA (noted FwGR_I) (3.9%), and the other newly identified as FGR (noted FwGR_II) (1.4%). In contrast, this approach allowed us to identify a group of ‘constitutionally small’ infants according to their constitutional growth potential (1.1%). In other words, among infants usually defined as SGA (5%), 22% appeared in fact to be ‘constitutionally small’ and therefore misclassified. As an initial validation, we observed that the proportion of maternal hypertension during pregnancy was low in the ‘constitutionally small’ infants (close to that of the normal group), and three times higher in the newly identified group FwGR_II than in the normal group. Following these results, it seems to be meaningful to follow-up this new group of FwGR_II infants, in terms of catch-up growth and neurodevelopmental outcome.

Objectives: After a previous study had shown the existence of psychological risk factors of pre-term delivery, we designed a study aimed at assessing the effect of psychotherapeutic support of pregnant women hospitalised with pre-term labour, followed by a second multicentric study aimed at demonstrating the reliability of such an intervention. Methods: Both studies were conducted in two successive cohorts of patients hospitalised with pre-term labour at 18–35 weeks of gestation. The initial study comprised 157 patients in each group, whereas the reliability study comprised 191 patients in the experimental group versus 202 in the control group. In each experimental group, the patients were offered psychotherapeutic support in addition to the usual clinical management. The psychological support included interviews with a psychologist and a collaborative work plan implemented with the nursing staff. Results: The analysis, conducted in the ‘intention to treat’ manner, shows a significant decrease in the early pre-term birth rate (Conclusion: This study offers new and major results related to the prevention of delivery before 35 weeks of gestation, both in the initial study as well as in the reliability study. Thus, providing this type of psychological support to women hospitalised for pre-term labour, in the context of antenatal care, can help to avoid early pre-term births and their complications in terms of brain damage and neuropsychological development.