Role of Maternal Serum Ferritin in the Prediction of Asymmetric Intrauterine Growth Restriction. Short running title: Ferritin predicts asymmetric IUGR

Background and aim: Asymmetric intrauterine growth restriction (IUGR) carries increased intrauterine and neonatal risks. Since most cases are idiopathic, identifying a predictive test remains an ideal prevention management. Maternal serum ferritin level is a potential predictor of later developing asymmetric IUGR.
Methods: Blood samples were drawn, at 30-32 gestational weeks, from 450 women who were then followed-up, resulting in 32 term pregnancies with asymmetric IUGR. The control group included the first recruited 32 women delivering adequate for gestational age ne- onates at term. Serum ferritin was then measured in the stored serum samples. Ultrasound scanning was performed at 30-32 weeks then at 37 weeks. Umbilical and middle cerebral artery Doppler scans were added at 37 weeks.
Results: Serum ferritin, at 30-32 weeks, was higher in women de- livering IUGR babies (19.3±6.83 vs 14±5.18, p<0.01). At 37 weeks, pregnancies with asymmetric IUGR had significantly (p<0.01) high- er umbilical artery resistance and pulsitility indices (0.71±0.06 vs 0.59±0.07 and 1.24±0.17 vs 0.86±0.09, respectively). Their mid- dle cerebral artery RI and PI were significantly (p<0.01) lower than controls (0.74±0.09 vs 0.81±0.05 and 1.64±0.07 vs 1.9±0.15, respectively). Ferritin level correlat- ed significantly with neonatal birthweight. A cut- off level >18.2 ng/mL had a sensitivity of 59.4% and a specificity of 90.6%. The area under curve showed an accuracy of 76.8%. Women with ferri- tin >18.2 ng/ml, were 10.23 times more likely to get asymmetrically growth restricted neonates (CI 2.89–36.17, p<0.001).

Conclusion: This study presents further evidence that maternal serum ferritin may be a useful test in the prediction of asymmetric IUGR.