ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
The Correlation of Umbilical Cord Blood Quality and Placental Function with Neonatal Outcomes in Fetal Growth Restriction
Lu Zou 1
Yanying Zeng 1
Liaoliao Zhao 1
Congying Shi 2
Chen Yang 1
Yanbin Zhu 1
1. Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China
2. Guangzhou Municipality Tianhe Nuoya Bio-engineering Co., Ltd, guangzhou, China
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Abstract
Background: Fetal growth restriction (FGR) poses significant risks to neonatal health, necessitating reliable prognostic indicators. This study evaluates predictive factors including umbilical cord blood parameters, placental function indices, and umbilical artery Doppler measurements for neonatal outcomes in FGR. Methods: This retrospective cohort study analyzed clinical records of 412 pregnant women with FGR admitted from January 2022 to December 2023. Participants were divided into favorable prognosis (5-minute Apgar score >7; n=310) and unfavorable prognosis (5-minute Apgar score ≤7, fetal demise, intrauterine fetal death, or neonatal death; n=102) groups. Data included demographic details, hematological and coagulation parameters, ultrasound findings, and umbilical cord blood gas analysis. Variance inflation factor (VIF) testing was performed to assess multicollinearity, and potential confounders including gestational age, birth weight, and neonatal sex were incorporated into multivariate analysis. Results: The unfavorable prognosis group demonstrated earlier gestational age at diagnosis (p=0.028) and birth (p=0.008), lower birth weight (p=0.003), and lower 5-minute Apgar scores (p<0.001). Routine blood and coagulation parameters showed no significant differences between groups. Placental function indices (Flow Index, Vascularization Index, Vascularization Flow Index) were significantly higher in the favorable group (all p<0.05). Umbilical artery Doppler parameters including pulsatility index (PI), resistance index (RI), and systolic/diastolic (S/D) ratio were significantly lower in the favorable group (all p<0.05). Umbilical cord blood analysis revealed higher pH (p=0.004), pO2 (p=0.014), and HCO3⁻ (p=0.010), with lower pCO2 (p=0.009) in the favorable group. Multicollinearity testing revealed acceptable VIF values (<5) for all predictors. Multivariate logistic regression, adjusted for gestational age, birth weight, and sex, identified elevated PI (OR=3.421, 95% CI: 1.284–9.112), RI (OR=18.652, 95% CI: 3.012–115.478), S/D ratio (OR=1.498, 95% CI: 1.168–1.922), and pCO2 (OR=1.046, 95% CI: 1.016–1.077), along with decreased pH (OR=0.001, 95% CI: 0.000–0.028), pO2 (OR=0.908, 95% CI: 0.831–0.992), and HCO3⁻ (OR=0.904, 95% CI: 0.824–0.992) as significant predictors. The model achieved an AUC of 0.795 (sensitivity 0.686, specificity 0.781) Conclusion: Elevated umbilical artery PI, RI, and S/D ratio, combined with impaired acid-base balance, are associated with unfavorable neonatal prognosis in FGR. These findings emphasize the importance of comprehensive monitoring of placental function and umbilical cord blood parameters in FGR-affected pregnancies.
Summary
Keywords
Apgar Score, fetal growth restriction, Neonatal outcomes, Placental function, prognosis, umbilical blood flow
Received
18 September 2025
Accepted
02 February 2026
Copyright
© 2026 Zou, Zeng, Zhao, Shi, Yang and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yanbin Zhu
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