We thank the authors for their thoughtful and constructive comments on our study evaluating the 2 main timing strategies of antenatal corticosteroid (CCS) in early-onset fetal growth restriction (FGR) in the Netherlands. , We appreciate their interest in the interpretation of the secondary neonatal outcomes, particularly the observed difference in necrotizing enterocolitis (NEC≥stage 2A).
The authors raise the question of whether additional adjustment for markers of disease severity—such as umbilical artery Doppler stage, duration of absent/reversed end-diastolic flow, or composite FGR staging—might clarify whether the higher NEC rate in strategy B reflects more advanced placental insufficiency rather than the CCS timing strategy itself. This is an interesting and relevant hypothesis that we are keen to explore in future analyses. However, we would like to emphasize that although fetuses in strategy B exhibited a more advanced FGR phenotype at the time of corticosteroid administration, as reflected by the presence or absence of reversed umbilical artery flow, gestational age at birth and birthweight were comparable between neonates in strategies A and B. Therefore, at the time of birth, the overall severity of the FGR phenotype may not have differed substantially between the 2 groups.
We thank the authors for their thoughtful considerations and constructive suggestions. Their comments highlight the complexity of studying early-onset FGR and underscore the importance of careful interpretation when disease progression and management strategies are inherently linked.
The authors report no conflict of interest.
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