Document Type : original article


1 Shahid AkbarAbadi Clinical Research Development unit (SHACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Department of perinatology, Shahid akbarabadi hospital, Iran University of medical sciences, Tehran, Iran.

3 Clinical research development center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran

4 Department of endocrinology and female infertility, reproductive Biomedicine Research center, Royan institute for reproductive Biomedicine, ACER, Tehran, Iran

5 Vali-E-Asr Reproductive Health Research Center, Family Health Research institute, Tehran University of Medical Science, Tehran, Iran


Background: Restriction of fetal growth is one of the major problems in gynecology and obstetrics for which no effective treatment has been proven so far. The disorder is associated with significant morbidity and perinatal mortality.
Methods: In this study, 104 pregnant women with SGA fetuses (3-10%) between preterm (>28 weeks) to full term were evaluated. The patients were divided into two groups: group A, the group with normal CPR as the reference group, and group B with abnormal CPR (ratio <1ref with normal UMA PI and Normal caldopler that were IUGR). Their demographic data including maternal age, gestational age, BMI of the pregnant mother, birth weight, fetal sex, and number of deliveries were examined.
Results: After collecting data and analyzing them, the results showed that the mean neonatal weight was 1432.81 (±560.81) in the abnormal CPR group, and 1845.42 (± 473.32) in the normal group. In addition, the mean Apgar scores of 5 and 1 minutes were significantly different between the groups, being lower in the abnormal CPR group (p-value <0.05). The results also revealed, Apgar scores of one and five minutes were significantly correlated with CPR and gestational age (p-value <0.05).
Conclusion: Finally, according to the data obtained from this study, it has been shown that CPR can be helpful as a predictive index of neonatal outcomes in patients with SGA.


  1. Zur RL, Parks WT, Hobson SR. The placental basis of fetal growth restriction. Obstetrics and Gynecology Clinics. 2020; 47(1):81-98.
  2. Liu Q, Yang H, Sun X, Li G. Risk factors and complications of small for gestational age. Pakistan journal of medical sciences. 2019; 35(5):1199.
  3. Damhuis SE, Ganzevoort W, Gordijn SJ. Abnormal fetal growth: small for gestational age, fetal growth restriction, large for gestational age: definitions and epidemiology. Obstetrics and Gynecology Clinics. 2021; 48(2):267-79.
  4. Nardozza LMM, Caetano ACR, Zamarian ACP, Mazzola JB, Silva CP, Marçal VMG, Lobo TF, Peixoto AB, Júnior EA. Fetal growth restriction: current knowledge. Archives of gynecology and obstetrics. 2017; 295:1061-77.
  5. Jensen EA, Foglia EE, Dysart KC, Simmons RA, Aghai ZH, Cook A, Greenspan JS, DeMauro SB. Adverse effects of small for gestational age differ by gestational week among very preterm infants. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2019; 104(2):F192-F8.
  6. de Mendonça ELSS, de Lima Macêna M, Bueno NB, de Oliveira ACM, Mello CS. Premature birth, low birth weight, small for gestational age and chronic non-communicable diseases in adult life: A systematic review with meta-analysis. Early human development. 2020; 149:105154.
  7. Figueras F, Gratacos E. An integrated approach to fetal growth restriction. Best practice & research Clinical obstetrics & gynaecology. 2017; 38:48-58.
  8. Lewandowska M. Maternal obesity and risk of low birth weight, fetal growth restriction, and macrosomia: multiple analyses. Nutrients. 2021; 13(4):1213.
  9. Campisi SC, Carbone SE, Zlotkin S. Catch-up growth in full-term small for gestational age infants: a systematic review. Advances in Nutrition. 2019; 10(1):104-11.
  10. Leavitt K, Odibo L, Nwabuobi C, Tuuli MG, Odibo A. The value of introducing cerebroplacental ratio (CPR) versus umbilical artery (UA) Doppler alone for the prediction of neonatal small for gestational age (SGA) and short-term adverse outcomes. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; 34(10):1565-9.
  11. Zarean E, Azami N, Shahshahan Z. Predictive value of middle cerebral artery to umbilical artery pulsatility index ratio for neonatal outcomes in hypertensive disorders of pregnancy. Advanced Biomedical Research. 2022; 11.
  12. Ciobanu A, Wright A, Syngelaki A, Wright D, Akolekar R, Nicolaides KH. Fetal Medicine Foundation reference ranges for umbilical artery and middle cerebral artery pulsatility index and cerebroplacental ratio. Ultrasound in Obstetrics & Gynecology. 2019; 53(4):465-72.
  13. Andrade EH, Soto E. The Cerebroplacental Ratio. Doppler Ultrasound in Obstetrics and Gynecology: Springer; 2023. p. 279-96.
  14. Zhou S, Guo H, Feng D, Han X, Liu H, Li M. Middle Cerebral Artery–to–Uterine Artery Pulsatility Index Ratio and Cerebroplacental Ratio Independently Predict Adverse Perinatal Outcomes in Pregnancies at Term. Ultrasound in Medicine & Biology. 2021; 47(10):2903-9.
  15. Hara-Isono K, Nakamura A, Fuke T, Inoue T, Kawashima S, Matsubara K, Sano S, Yamazawa K, Fukami M, Ogata T, Kagami M. Pathogenic Copy Number and Sequence Variants in Children Born SGA With Short Stature Without Imprinting Disorders. The Journal of Clinical Endocrinology & Metabolism. 2022; 107(8):e3121-e33.
  16. Freire BL, Homma TK, Funari MFA, Lerario AM, Vasques GA, Malaquias AC, Arnhold IJP, Jorge ALL. Multigene Sequencing Analysis of Children Born Small for Gestational Age With Isolated Short Stature. The Journal of Clinical Endocrinology & Metabolism. 2019; 104(6):2023-30.
  17. Pérez-Cruz M, Cruz-Lemini M, Fernández MT, Parra JA, Bartrons J, Gómez-Roig MD, Crispi F, Gratacós E. Fetal cardiac function in late-onset intrauterine growth restriction vs small-for-gestational age, as defined by estimated fetal weight, cerebroplacental ratio and uterine artery Doppler. Ultrasound in Obstetrics & Gynecology. 2015; 46(4):465-71.
  18. Rial-Crestelo M, Martinez-Portilla RJ, Cancemi A, Caradeux J, Fernandez L, Peguero A, Gratacos E, Figueras F. Added value of cerebro-placental ratio and uterine artery Doppler at routine third trimester screening as a predictor of SGA and FGR in non-selected pregnancies. The Journal of Maternal-Fetal & Neonatal Medicine. 2019; 32(15):2554-60.
  19. Monteith C, Flood K, Pinnamaneni R, Levine TA, Alderdice FA, Unterscheider J, McAuliffe FM, Dicker P, Tully EC, Malone FD, Foran A. An abnormal cerebroplacental ratio (CPR) is predictive of early childhood delayed neurodevelopment in the setting of fetal growth restriction. American Journal of Obstetrics and Gynecology. 2019; 221(3):273. e1-. e9.