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What’s new in the other journals?

Early pregnancy growth It appears that fetal growth in the first trimester is an indicator of growth in late pregnancy. By measuring the crown to rump length ultrasonically between 10 and 14 weeks, it seems possible to predict which pregnancies are at risk of later complications, such as growth restrictions, preterm delivery and stillbirth. A study by Mook-Kanamori et al. (JAMA 2010;303:527–34) compared the actual length with the predicted length of fetuses of women who were sure of the first day of their last menstrual period (LMP). When the fetus was smaller than expected, the chances of ‘placentation-related’ complications rose, irrespective of the mother’s height or weight. The further behind the norm for the gestational age, the greater the risk of a poor outcome later. The accuracy of the data relies on the woman’s recall of her LMP and that conception occurred on day 14 of her cycle, but it is also possible that late ovulation is associated with an increased risk of chromosomal abnormalities which are more likely to have lower growth velocities and more suboptimal outcomes. The researchers from the Netherlands showed that poor growth was associated with maternal age, diastolic blood pressure and haematocrit, as well as smoking and the failure to use folic acid supplementation. Factors linked to optimal first trimester growth were increasing maternal age up to 32 years, folate supplement use and higher education levels, whereas factors linked to shorter crown to rump length were a raised diastolic blood pressure reading, higher haematocrit, non-Dutch ethnicity and smoking. Those in the lowest 20% of measurements were twice as likely to have pregnancy complications as those falling within the normal range. This cohort was also more likely to demonstrate accelerated early catch-up growth which was completed in the first 2 years of life, but is associated with long-term chronic cardiovascular and metabolic disease. As Smith points out in an editorial (JAMA 2010;303:561–2), the combination of placental protein levels, such as pregnancyassociated plasma protein A, placental growth factor and activin A, plus ultrasound measurements needs to be investigated to create a robust screening tool to identify women at risk of complications in late pregnancy. Interventions will also need development, but these data move the very early diagnosis of at-risk pregnancies a step closer.