Investigating fetal growth restriction due to placental insufficiency in the 35–40 age group

Abstract

Purpose: Fetal growth restriction (FGR) due to placental insufficiency is a growing concern, particularly in women of advanced maternal age. With the global trend toward delayed childbearing, it is important to evaluate whether routine screening methods such as umbilical artery Doppler (UAD) should be introduced in this population. Objectives: The study aimed to assess whether UAD measurements can identify FGR risk in women aged 35–40 years; compare UA blood flow parameters between FGR-affected and unaffected pregnancies in this age group; and determine if sociodemographic and obstetric factors influence fetal blood flow. Methodology: A quantitative, prospective, quasi-experimental design was employed, recruiting 198 pregnant women aged 35–40 years in their third trimester from a public general hospital in Malta. Each participant underwent a UAD and fetal biometry scan. A control group of 16 high-risk FGR participants was included for comparison. Participants completed a questionnaire on sociodemographic characteristics and medical history. Statistical analyses were performed to compare fetal growth parameters between groups. Results: The study revealed statistically significant higher mean pulsatility index, resistance index, and systolic/diastolic ratios in the control group, indicating increased placental insufficiency (p<0.001) in FGR-affected fetuses. Conversely, mean fetal biometrics, including head circumference, abdominal circumference, and estimated fetal weight (EFW) % were significantly higher in the experimental study group (p<0.001). Ethnic differences were observed, with white participants having a higher EFW% compared to other groups (p=0.029). Parity and smoking were the only characteristics that were statistically significantly associated with fetal growth parameters. Conclusion: This study demonstrated that UAD indices were significantly higher in FGRaffected pregnancies in women aged 35–40 years. Although no correlation with maternal age was found, further research should investigate routine Doppler use, personalised monitoring, standardised US techniques, and tailored prenatal care to further explore whether it’s possible to improve detection and management of FGR in this age group.