(391) Long-Term Neurological Outcomes of Offspring Misdiagnosed as Intrauterine Growth Restriction

Intrauterine fetal growth restriction (IUGR) is a major determinant of adverse perinatal and long-term outcomes. Current definition of IUGR may lead at times to a false diagnoses of fetuses that are eventually born appropriate for gestational age (AGA). We aimed to study whether a false antepartum IUGR diagnosis is associated with offspring long-term neurological outcomes during childhood.

Study Design:

A population-based cohort analysis was performed including deliveries between the years 1991-2022 in a tertiary hospital. We compared neurological hospitalization during childhood (involving a predefined set of ICD9 codes) among AGA infants misdiagnosed as IUGR versus AGA infants without a false IUGR diagnosis. A Kaplan-Meier survival curve was used for cumulative morbidity and a Cox proportional hazards model was constructed to control for confounders.

Results:

During the study period, 324,620 AGA infants met the inclusion criteria. 3,249 of them were falsely classified as IUGR. These offspring had higher rates of hospitalizations due to various neurological conditions, as compared to those without a false IUGR diagnosis (OR=1.4, 95% CI 1.3-1.6; P< 0.001; Table). In addition, cumulative hospitalization incidence was elevated in the falsely diagnosed IUGR group (log-rank P-value < 0.001; Figure). When controlling for confounders, a false IUGR diagnosis remained independently associated with long-term neurological morbidities (adjusted HR = 1.12, 95% CI 1.0 – 1.25, P< 0.05).

Conclusion:

Misdiagnosis of IUGR in the antepartum period is associated with an increased risk for offspring long-term neurological morbidity.