TY - JOUR T1 - Identifying the High-Risk Fetus in the Low-Risk Mother Using Fetal Doppler Screening JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00692 VL - 10 IS - 3 SP - e2100692 AU - Ute Feucht AU - Tsakane Hlongwane AU - Valerie Vannevel AU - Helen Mulol AU - Tanita Botha AU - Robert Pattinson Y1 - 2022/06/29 UR - http://www.ghspjournal.org/content/10/3/e2100692.abstract N2 - Key FindingsInfants who had an abnormal umbilical artery resistance index during pregnancy had a significantly lower fat-free mass (reflecting bone and muscle mass) at 6 weeks, 10 weeks, 14 weeks, and 6 months postpartum when compared to infants with normal umbilical artery resistance indices.The use of continuous-wave Doppler ultrasound can identify the fetus at risk of fetal growth restriction and allows for appropriate interventions to save the fetus and change the antenatal and postnatal trajectory.Key ImplicationsScreening with continuous-wave Doppler ultrasound has the potential to save lives but may burden already strained low-resource settings.The identification of this group of vulnerable fetuses with abnormal Doppler results allows for further research and interventions to optimize growth and other health outcomes, both antenatally and postnatally.Identifying the high-risk fetus in the low-risk pregnant mother (LRM) is a neglected area of research. Fetal growth restriction (FGR) is a major cause of stillbirths, especially in low- and middle-income countries (LMICs). FGR is very poorly detected particularly in healthy pregnant women classified as low risk. Umbiflow is an inexpensive continuous-wave Doppler ultrasound (CWDU) apparatus that is suitable for use by low-level health care providers for screening low-risk pregnant populations. It can easily detect umbilical artery blood flow in the cord, which correlates well with placental function, and poor placental function correlates well with FGR.Use of CWDU to screen an LMIC population of more than 7,000 LRMs has demonstrated a high prevalence of abnormal umbilical artery flow of 13%, and absent end-diastolic flow, which is associated with end-stage placental disease, was found in 1.2%. This is 10 times higher than previously reported in high-income countries. Screening with CWDU together with a standard protocol managing those pregnancies with abnormal placental blood flow resulted in a 43% reduction in stillbirths (risk ratio: 0.57; 95% confidence interval=0.29, 0.85) in this LRM population. Further, follow-up of infants who had abnormal umbilical artery blood flow showed that these infants had significantly less fat-free mass at ages 6 weeks, 10 weeks, 14 weeks, and 6 months, than those with normal umbilical artery blood flow (P<.015), confirming that CWDU was able to detect true FGR.Thus, screening with CWDU can detect the fetus at risk of stillbirth, and infants likely to have suboptimal growth and development postnatally. Screening with CWDU in LRMs opens the door to a step change in preventing stillbirths in LMICs. ER -