TOPLINE:

Pregnancies complicated by extremely early-onset foetal growth restriction (FGR), defined as a diagnosis ≤ 26 weeks of gestation, had a high risk for adverse outcomes, including perinatal death, genetic and structural anomalies, and preeclampsia. Nearly half of these affected pregnancies had preterm births ≤ 32 weeks of gestation.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis to evaluate perinatal and maternal outcomes in singleton pregnancies complicated by extremely early-onset FGR.
• Among 14 studies (2818 pregnancies) included in the systematic review, 13 (2573 pregnancies) were included in the meta-analysis.
• The primary outcome was perinatal death, including both intrauterine and neonatal death.

TAKEAWAY:

• Overall, perinatal death occurred in 16.0% of pregnancies with extremely early-onset FGR, with intrauterine and neonatal death occurring in 8.8% and 6.2%, respectively.
• Genetic and structural anomalies were identified in 9.6% and 23.2% of foetuses, respectively.
• Preeclampsia affected 21.6% of pregnancies. Preterm birth before 32 and 28 weeks of gestation occurred in 54.6% and 23.3% of pregnancies, respectively; 45.6% of women underwent caesarean section.
• Overall, 30.5% of infants had composite adverse perinatal outcomes, including perinatal death, any perinatal morbidity, and/or NICU admission; 38.3% showed neurologic morbidity; 21.7% showed respiratory distress syndrome; and 61.8% had intact survival during the follow-up.

IN PRACTICE:

"Women with a fetus affected by extremely early-onset FGR should be counseled on the high risk of short- and long-term maternal morbidity associated with Cesarean section, which should be balanced against the high risk of PND [perinatal death] and significant perinatal morbidity due to prematurity," the authors wrote.

SOURCE:

This study was led by M. Piergianni, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy. It was published online on November 14, 2025, in Ultrasound in Obstetrics & Gynecology.

LIMITATIONS:

Some of the included studies had small sample sizes and had adopted a retrospective non-randomised design. Standardised criteria for the antenatal surveillance and timing of delivery in foetuses with extremely early-onset FGR were lacking. Significant heterogeneity was observed across many pooled analyses.

DISCLOSURES:

No funding information was provided for this study. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.