The correlation of umbilical cord blood quality and placental function with neonatal outcomes in fetal growth restriction

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-min Apgar score >7; n = 310) and unfavorable prognosis (5-min 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-min 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), pO 2 ( p = 0.014), and HCO 3 − ( p = 0.010), with lower pCO 2 ( p = 0.009) in the favorable group. Multicollinearity testing revealed acceptable VIF values (