UP researchers use low-cost device to detect foetal growth restriction

Researchers at the University of Pretoria (UP) have shown that a low-cost, easy-to-use screening device can detect foetal growth restriction in pregnant women, which, if not diagnosed, can lead to stillbirth, neonatal death or suboptimal childhood growth.  

The work was done at UP’s Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies and published in peer-reviewed journal PLoS ONE.

Dr Helen Mulol of the research centre and co-author of the study explains, "The UmbiflowTM is a portable, continuous-wave Doppler ultrasound device that was developed in South Africa and costs about one-tenth of a conventional ultrasound device.  All healthcare workers, including nurses, can be trained relatively quickly to operate it. The device can be connected to a computer, tablet or smartphone and a printer can be attached to print out results".

Healthcare workers would use the UmbiflowTM to find the wave pattern of the umbilical artery which indicates the blood flow between the baby and the placenta.

From this wave pattern, a parameter called the resistance index (RI) can be calculated. The result of the RI, according to the gestational age of the baby, is plotted on a graph, with the next clinical management steps then being determined according to a “traffic light” system. According to risk categorisation, an RI value in the red or yellow region of the graph is classified as an “abnormal Doppler” and the mother is referred to an obstetrician or doctor for further investigation. An RI value in the green area is classified as a “normal Doppler”; this means the mother can continue antenatal follow-up visits at a local clinic.  

The Doppler result is important because it is a measure of placental function – the rate of blood flow from the placenta to the foetus. Dr Mulol says foetal growth restriction can be defined as failure of the foetus to reach its genetic growth potential. “It does not mean that all growth-restricted babies are small,” she says. “It also does not mean that all small babies are growth restricted; some are just constitutionally small. Foetal growth restriction means the foetus is not growing as well as it should be in utero, which is exactly the group of babies that can be identified by the Doppler.”

Professor Ute Feucht – Director of the Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, and lead author of the study – explains the implications: “The foetus is not receiving enough nutrition and oxygen in utero and therefore does not grow optimally. If this is not picked up, the foetus is at risk of stillbirth and neonatal death.”

There might also be long-term consequences such as the risk of neurodevelopmental delay and non-communicable diseases later in life. These include childhood obesity as well as type 2 diabetes, hypertension and strokes in adults.

What was done during the study?

The UmbiflowTM international study recruited healthy pregnant mothers in five low- and middle-income countries – Ghana, India, Kenya, Rwanda and South Africa – and looked at the percentage of abnormal Dopplers in these countries.

The UmbiBaby study is following up on 91 infants from the South African leg of the international study, assessing them at eight time points over the first two years of life. The PLoS ONE article studied the term-born infants (81) in the first six months of life. The main finding, according to Prof Feucht, was that the growth restriction identified in pregnancy by the UmbiflowTM device continued after birth.

Infants who had an “abnormal Doppler” in utero had a significantly lower fat-free mass (the non-fat portion of the body, which includes bones and muscles). It is also notable that only about a quarter of these infants were small-for-gestational age at birth, which is classified as a birthweight less than that of the 10th percentile.

The assessment of weight at birth would not have identified many of these growth-restricted infants, who may be in need of additional nutritional and neurodevelopment care postpartum. When taking the two definitions together, the growth-restricted infant (as identified by the “abnormal Doppler”) and small-for-gestational age is the most compromised in terms of postnatal growth.

It is therefore recommended that a Doppler device such as the UmbiflowTM, which measures placental function, be utilised routinely during antenatal care, in addition to measuring the infant’s size at birth, as the latter is a once-off measurement that could fail to take into account the infant who might not be small at birth, but who is still at risk of poor growth postnatally.

Click on the infographic in the sidebar to learn more about stillbirths or click the gallery to see how the UmbiflowTM works.

Dr Helen Mulol

April 4, 2022

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  • Dr Helen Mulol
    Dr Helen Mulol works at the University of Pretoria’s (UP) Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies. She is the Principal Investigator and Study Coordinator of the UmbiBaby study, which is following up on the babies from the South African site of the UmbiflowTM international study. Sponsored by the World Health Organisation, this study used the innovative low-cost UmbiflowTM device to screen for in utero growth restriction due to placental insufficiency.

    Dr Mulol obtained an MSc in Analytical Chemistry and a PhD in Paediatrics (2016) from the University of KwaZulu-Natal (UKZN). For her doctoral research, she conducted a longitudinal study of breastfeeding infants in the first year of life. Dr Mulol strongly advocates exclusive breastfeeding, having come to realise the powerful properties of breast milk through her research. Breast milk changes its composition according to a mother’s diet and to the infant’s age; it also has immune-boosting properties. This is vastly different to baby formula found on supermarket shelves which does not change in any way.

    She utilised an objective method during her research to determine how much breast milk mothers were giving their infants at five time points in the first year of life and whether they were exclusively breastfeeding in the first six months of life. The samples generated from these studies are measured using an analytical chemistry method.

    Dr Mulol received a scholarship from the International Atomic Energy Agency for her PhD studies. The agency, which is part of the United Nations and based in Vienna, Austria, promotes the use of stable isotopes in fields such as nutrition.

    After completing her PhD, Dr Mulol became involved at UKZN in coordinating another longitudinal study. This study investigated the likelihood of HIV-exposed, uninfected infants needing a daily dose of CTX, an antibiotic, by looking primarily at the health outcomes of those who received the antibiotic and those who didn’t.
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  • Professor Ute Feucht
    Professor Ute Feucht is the Director of the University of Pretoria’s (UP) Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies and of the South African Medical Research Council’s Maternal and Infant Health Care Strategies Unit, which is based at UP.

    Prof Feucht has a joint appointment in Gauteng, where she works as a paediatrician as part of the Tshwane District Clinical Specialist Team, a multi-disciplinary unit of specialists tasked with improving maternal and child health services, and outcomes at district level.

    She graduated in 1995 with a degree in Medicine (cum laude) from Stellenbosch University and specialised in Paediatrics at UP, before obtaining her PhD in Paediatrics at Stellenbosch University.

    Prof Feucht’s research addresses broad questions of child health, with a focus on the prevention of mother-to-child transmission, paediatric HIV treatment and care, childhood nutrition and growth, and improving childhood morbidity and mortality. She also works on the development of data systems to improve clinical care and monitor health outcomes. Much of her work is informed by the “survive, thrive, transform” principle, with the ultimate goal of improving the outcomes of children and their families within the communities she works in, in South Africa and beyond.

    The work of UP’s Research Centre for Maternal, Infant and Child Health Care Strategies is a collaboration between Obstetrics, Paediatrics, Nutrition, Immunology and Health Care Provision, with a strong nation-wide implementation and research footprint. The centre also works very closely with national and provincial departments of health.
    The centre aims to be a leader in the field of perinatal healthcare by improving the neurodevelopment of children and seeking saleable, sustainable solutions to prevent maternal, foetal, newborn and child morbidity and mortality in the primary and secondary levels of care.

    Being part of the Umbiflow research team has been a recent research highlight for Prof Feucht. The obstetric section of this work has shown the UmbiflowTM device – a continuous-wave Doppler ultrasound – to be a groundbreaking innovation in the detection and prevention of foetuses that are at risk of stillbirth. A pilot study has been established in nine sites in South Africa. The extension of this work into the paediatric and nutrition fields has highlighted the ability of this device to detect previously undetected in utero growth restriction and has introduced a new, exciting field of research.

    • NRF rating: C2
    • Research Gate profile: https://www.researchgate.net/profile/Ute-Feucht

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