Maternal & Newborn Atlas
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Late growth restriction is often missed before birth

Small babies are often not recognised before birth when scans are done only when there is a clinical reason. In one English study of first-time mothers, scans done only for clinical reasons found one in five babies who were later born small, while extra scans at 28 and 36 weeks found more than half. That study did not test whether acting on the extra scans helps babies.

  • Bottleneck
  • In this atlas

Overview

Technical summary

In the Pregnancy Outcome Prediction cohort (Cambridge, 3977 nulliparous women), sensitivity for small-for-gestational-age (SGA, birth weight below the 10th percentile) was 20% with selective ultrasonography and 57% with hidden universal ultrasonography (relative sensitivity 2.9). SGA includes healthy small babies, so this measures detection of small size, not of pathological growth restriction; the study also found that SGA risk was raised mainly when abdominal circumference growth velocity was in the lowest decile. Funders include GE Healthcare.

Scope

Nulliparous women with singleton pregnancies in one UK cohort; the effect on outcomes of acting on universal scanning is not tested in the source read

Stage
Detection of small babies before birth, third-trimester scanning
Why it is severe
The POP authors say fetal growth restriction is a major determinant of adverse perinatal outcome, and that screening must separate healthy small babies from pathologically small ones.

Burden

  • Description Observational Certainty not assessed

    In the Pregnancy Outcome Prediction cohort in Cambridge, nulliparous women with a viable singleton pregnancy had clinically indicated third-trimester ultrasound as usual (selective ultrasonography) and, in addition, research ultrasound with fetal biometry at 28 and 36 weeks whose results were not shown to women or clinicians (universal ultrasonography). Among 3977 women eligible for analysis, sensitivity for detecting small-for-gestational-age (SGA) infants, defined as birth weight below the 10th percentile, was 20% (69 of 352) with selective ultrasonography and 57% (199 of 352) with universal ultrasonography (relative sensitivity 2.9, 95% CI 2.4 to 3.5). The authors say universal third-trimester biometry roughly tripled detection of SGA infants. A fetus with an estimated weight below the 10th percentile had an increased risk of neonatal morbidity (relative risk 1.60, 95% CI 1.22 to 2.09), but only if the abdominal circumference growth velocity was in the lowest decile (relative risk 3.9, 95% CI 1.9 to 8.1).

    Source problem. A cited source is corrected. Check the sources before relying on this claim.

    Applies to Fetal
    • Fetuses of nulliparous women with a viable singleton pregnancy at the dating scan who attended research scans and had a livebirth at the Rosie Hospital, Cambridge. 4512 women consented and 3977 (88%) were eligible for analysis. The women are the people recruited; the fetuses are the people scanned and then classified by birth weight.
    • One UK teaching hospital; research ultrasound at 28 and 36 weeks of gestation alongside routine care
    • United Kingdom (Cambridge)
    • Pregnancy, third trimester scans at 28 and 36 weeks; births after the 28-week scan
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Birth weight for gestational age and neonatal morbidity
    Certainty method
    Not assessed
    Limitations
    SGA is a birth-weight measure and includes healthy small babies, so it is not the same as growth restriction. The study scanned nulliparous women at one hospital, and the research results were hidden, so it did not test whether acting on universal scanning improves outcomes for babies. The study funders include GE Healthcare, a maker of ultrasound equipment (PubMed funding statement). The linked erratum (PMID 28831976) was read: it corrects the declaration of interests, which now lists other support from GE for one author, and it does not change the figures cited here. Only the abstract was read.
    Last checked
    2026-10-14
    Next evidence check due
    Not scheduled
    Sources and citations (18)

    1. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, METHODS, sentence 1, fragment 1 of 2
      How it applies
      PubMed abstract.
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      Not reported
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      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    2. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, METHODS, sentence 1, fragment 2 of 2
      How it applies
      PubMed abstract.
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      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    3. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, METHODS, sentence 2
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    4. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, METHODS, sentence 3
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
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      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    5. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, METHODS, sentence 4
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    6. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, METHODS, sentence 5, fragment 1 of 2
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    7. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, METHODS, sentence 5, fragment 2 of 2
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    8. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, FINDINGS, sentence 1
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    9. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, FINDINGS, sentence 2, fragment 1 of 2
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    10. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, FINDINGS, sentence 2, fragment 2 of 2
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    11. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, FINDINGS, sentence 3, fragment 1 of 2
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    12. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, FINDINGS, sentence 3, fragment 2 of 2
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    13. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, FINDINGS, sentence 4, fragment 1 of 2
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    14. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, FINDINGS, sentence 4, fragment 2 of 2
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    15. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, INTERPRETATION, sentence 1
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    16. Supports Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study

      Publication · Lancet (London, England) · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities, retrieved 2026-10-14. The full text and the version of record were not read. · Published 2015-11-21 · DOI: 10.1016/S0140-6736(15)00131-2 · PMID: 26360240

      Locator
      Abstract, FUNDING, sentence 1
      How it applies
      PubMed abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      88b79713119757d5834460a938b74e852129b2188446669122bdd3d365f0f3ea
      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

    17. Background Department of Error

      Publication · Lancet (London, England) · Edition PMC Open Access subset article (a published correction), full-text XML from NCBI E-utilities, retrieved 2026-10-14. · PMCID: PMC5605878 · PMID: 28831976 · DOI: 10.1016/S0140-6736(15)00976-9

      Locator
      Body, paragraph 1, sentence 1, fragment 1 of 2
      How it applies
      Frames the population or setting. Source page.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      9532203234cb27ec1e7b0a6e41d06939dfe040c9119edc63a611049b5d70de64
      Reuse basis
      PMC Open Access subset article under https://creativecommons.org/licenses/by/3.0/. The article's own <permissions> states the licence. The XML is committed unaltered, with the citation and licence kept in the file. The raw file is committed at research/snapshots/mf-pmc-PMC5605878.xml.

    18. Background Department of Error

      Publication · Lancet (London, England) · Edition PMC Open Access subset article (a published correction), full-text XML from NCBI E-utilities, retrieved 2026-10-14. · PMCID: PMC5605878 · PMID: 28831976 · DOI: 10.1016/S0140-6736(15)00976-9

      Locator
      Body, paragraph 1, sentence 1, fragment 2 of 2
      How it applies
      Frames the population or setting. Source page.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      9532203234cb27ec1e7b0a6e41d06939dfe040c9119edc63a611049b5d70de64
      Reuse basis
      PMC Open Access subset article under https://creativecommons.org/licenses/by/3.0/. The article's own <permissions> states the licence. The XML is committed unaltered, with the citation and licence kept in the file. The raw file is committed at research/snapshots/mf-pmc-PMC5605878.xml.

Current efforts

Record details

Record id
maternal:bottleneck-late-fgr-detection
Content hash
2eb9bb0c611f4b1e27f3c0e5b8de7521e9b2c456f45cb00e29a80b1ab1612995