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DOI: 10.1055/a-2682-5886
Fetal body composition and organ growth in pregnancies complicated by first trimester vaginal bleeding status: NICHD Fetal 3D Study
Supported by: Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health HHSN275201300026I,HHSN275201500002C
Supported by: NICHD Fetal Growth Studies – Singletons HHSN27500006,HHSN275200800002I,HHSN275200800003IC,HHSN275200800012C,HHSN275200800013C,HHSN275200800014C,HHSN275200800028C,HHSN275201000009C Clinical Trial: Registration number (trial ID): NCT00912132, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective cohort AND Registration number (trial ID): NCT03266198, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective cohort
Objective: To explore associations between self-reported first trimester vaginal bleeding status and fetal body composition and organ volumes measured by 3-Dimensional (3D) ultrasound across pregnancy. Study Design: The NICHD Fetal 3D Study (2015-2019) included individuals with singleton pregnancies at low risk for fetal growth abnormalities (n=2,634). Fetal body composition measures of arm, abdomen, and thigh, and organ volumes including cerebellum, lung, kidney, and liver, were measured up to five times between 15-40 weeks using 3D ultrasound. Women were grouped by cumulative days of self-reported first trimester vaginal bleeding: 0 (no bleeding, reference), 1, or >1 day. Linear mixed models, with quadratic and cubic terms for gestational age, including global tests for overall differences in trajectories and weekly pairwise comparisons, were fit to compare groups by fetal anthropometric measures, adjusted for maternal age, race/ethnicity, pre-pregnancy body mass index, parity, and infant sex. Results: Most women had no bleeding (n=2,144, 81.4%), while 211 (8.0%) reported 1 day and 279 (10.6%) reported >1 day. Compared to no bleeding, fetuses of women with >1 day of bleeding had 75.1 to 264.0 mm2 smaller abdominal area between 30-40 weeks, 1.1 to 4.0 cm3 smaller fractional thigh volume between 33-40 weeks, 0.4 to 2.4 cm3 smaller fractional fat thigh volumes between 30-40 weeks, and 0.8 to 1.6 cm3 larger cerebellar volumes between 35-40 weeks. Fetuses of women with 1 day of bleeding had 2.6 to 4.8 cm3 smaller liver volume between 26-35 weeks compared to no bleeding. Conclusion: First trimester bleeding was associated with smaller fetal abdominal area and decreased adiposity compared to no bleeding, whereas organ growth trajectories were increased for the cerebellum and decreased for the liver. Fetal 3D measures may provide insight into how first trimester gestational bleeding potentially influences fetal growth and development with implications for possible postnatal health outcomes.
Publication History
Received: 20 May 2025
Accepted after revision: 13 August 2025
Accepted Manuscript online:
14 August 2025
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