Progress in prevention and treatment of placenta-derived fetal growth restriction

Fetal growth restriction is a common obstetric complication that is a major cause of stillbirth,neonatal death,neurological abnormalities in newborns,cognitive impairment in children,and metabolic abnormalities in adulthood.However,there is a lack of effective prediction and prevention methods in clinical practice,and perinatal intervention measures are scarce,and the therapeutic effect is not ideal.Based on a number of current studies,it has been found that low-dose aspirin can reduce the incidence of preeclampsia and FGR in high-risk pregnancies.Therefore,FIGO,RCOG, SOGC and other guidelines recommend that high-risk women start to take 100mg-150mg/d aspirin before 16 weeks for prevention,while there is no uniform conclusive standard for high-risk women.However,ACOG and SMFM guidelines do not recommend the routine use of low-dose aspirin solely for the prevention of FGR. There is still controversy about whether to add heparin to high-risk women.Current studies have shown that low molecular weight heparin does not reduce the risk of placentan-mediated pregnancy complications recurrence in high-risk women,but it may improve fetal and neonatal outcomes in women with placentan-mediated FGR. Therefore,more large-scale,high-quality clinical trials are needed to verify its effect. And further clarify the best treatment plan and use time.Clinical trials of sildenafil have suggested that it may increase birth weight and prolong the gestational period of delivery,but studies have also suggested that sildenafil may increase the risk of pulmonary hypertension in newborns.Therefore,sildenafil should not be used for FGR until the efficacy of sildenafil in the treatment of FGR is clear.Other potential therapies to improve placental circulation are under ongoing research,such as nitric oxide donor,maternal VEGF gene therapy,melatonin,L-arginine,nanotechnology and other utero-placental targeting strategies,acetylcysteine,hydrogen sulfide,creatine, pioglitazone,artificial hemoglobin protein,proton pump inhibitors,metformin,etc. Although it may indicate efficacy in animal studies.