Women who are immigrants may be at particular risk for poor fetal growth. In one study of 56,443 singleton pregnancies in Rotterdam, social deprivation was associated with adverse perinatal outcomes that included SGA newborns (Poeran, 2013). That said, a similar linkage was not found in socially deprived women of non-Western origin. The efect of immigration, however, is complex and dependent on the population studied (Howell, 2017; Sanchez-Vaznaugh, 2016).
Especially when complicated by superimposed preeclampsia, chronic vascular disease commonly causes growth restriction (Chap. 50, p. 980). In a study of more than 2000 women, vascular disease as evidenced by abnormal uterine artery Doppler velocimetry early in pregnancy was associated with higher rates of preeclampsia, SGA neonates, and delivery before 34 weeks (Groom, 2009). Using Washington state birth certiicate data, Leary and colleagues (2012) found that maternal ischemic heart disease was linked to SGA infants in 25 percent of 186 births. Roos-Hesselink and coworkers (2013) described similar pregnancy outcomes in 25 women with ischemic heart disease.
Chronic renal insuiciency is frequently associated with underlying hypertension and vascular disease. Nephropathies are commonly accompanied by restricted fetal growth (Cunningham, 1990; Feng, 2015; Saliem, 2016). hese relationships are considered further in Chapter 53 (p. 1034).
Fetal-growth restriction in the newborns of women with diabetes may be related to congenital malformations or may follow substrate deprivation from advanced maternal vascular disease (Chap. 57, p. 1100). Also, the likelihood of restricted growth increases with worsening White classification, particularly nephropathy (Klemetti, 2016). hat said, the prevalence of serious vascular disease associated with diabetes in pregnancy is low, and the primary efect of overt diabetes, especially type 1, is fetal overrowth. For example, in a prospective study of 682 consecutive pregnancies complicated by diabetes, women with type 1 diabetes were significantly more likely than women with type 2 diabetes to have a neonate weighing above the 90th and 97.7th percentiles (Murphy, 2011). Additionally, women with type 1 diabetes were significantly less likely to deliver an SGA newborn. In a recent study of 375 term singleton pregnancies complicated by type 1 diabetes, the risk of fetal overgrowth correlated with rising third-trimester glycemic values (C yganek, 2017) . Nearly a fourth of neonates were macrosomic. And, third-trimester hemoglobin Al c and fasting glucose values were independent predictors for the risk of macrosomia.