The study in this issue of JAMA by Mook-Kanamori et al2 presents important new information about first-trimester determination of growth restriction. The authors measured the difference between the expected size of the fetus in the first trimester, based on menstrual history, and the actual size of the fetus, assessed by ultrasound. They demonstrated that when the fetus was smaller than expected in the first trimester, there was an increased risk of preterm birth, delivery of a small-for-gestational age (SGA) infant, and delivery of a low-birth-weight infant. The associations were independent of other maternal characteristics and the risk of these outcomes was increased 2 to 3 fold among fetuses in the lowest quintile of first-trimester growth.
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