Can Fetal Growth Velocity and First Trimester Maternal Biomarkers Improve the Prediction of Small-for-Gestational Age and Adverse Neonatal Outcome?

Abstract

<b><i>Background and Objectives:</i></b> The aim of this study was to evaluate the value of adding fetal growth velocity and first trimester maternal biomarkers to baseline screening, for the prediction of small-for-gestational age (SGA) and adverse neonatal outcomes. <b><i>Method:</i></b> A retrospective cohort study was conducted of singleton pregnancies in the Maastricht University Medical Centre between 2012 and 2016. The biomarkers PAPP-A, β-hCG, PlGF, and sFlt-1 were measured at 11–13 weeks of gestational age (GA) and two fetal growth scans were performed (18–22 and 30–34 weeks of GA). Differences in biomarkers and growth velocities were compared between appropriate-for-gestational age (AGA; birth weight percentile 10–90) and SGA (birth weight percentile <10). Combinations of the biomarkers and fetal growth velocity were added to baseline screening for the prediction of SGA and adverse neonatal outcome. <b><i>Results:</i></b> We included 296 singleton pregnancies. Compared to AGA (<i>n</i> = 251), SGA neonates (<i>n</i> = 45) had significantly lower growth velocities in the abdominal circumference (mm/week): 10.1 ± 0.98 versus 10.8 ± 0.98, <i>p</i> = 0.001. Compared with AGA, the SGA neonates had higher sFlt-1 multiples of the median (MoM): 0.89 (0.55) versus 0.76 (0.44), <i>p</i> = 0.023, and a higher sFlt-1/PlGF MoM ratio: 1.09 (1.03) versus 0.90 (0.64), <i>p</i> = 0.027. For a 15% false-positive rate, the prediction of SGA neonates increased from 44.8% for the baseline screening model to 56.5% after the addition of fetal growth velocities, and to 73.9% after the further addition of maternal biomarkers (PPV 9.6%, NPV 82.4%). The corresponding AUC for the three models were 0.722, 0.804, and 0.839, respectively. In addition, AGA neonates with reduced fetal growth velocity had more adverse neonatal outcomes compared to the AGA reference group (12.4 vs. 3.9%, <i>p</i> = 0.013). <b><i>Conclusions:</i></b> Combining fetal growth velocity with first trimester biomarkers resulted in a better prediction of SGA compared to baseline screening parameters alone. This approach could possibly result in reduced adverse neonatal outcomes in neonates, who are at a potential risk due to late mild placental dysfunction.

Role of first trimester screening test in predicting the perinatal outcomes in low risk term pregnancies

“…As far as we are concerned, there are few studies evaluating fetal weight and the well-being of the fetus with first-trimester NT measurements. [5] The number of patients was lower in previous studies when compared to the present study. We believe that the study contributes to the literature because the number of patients was significantly higher, and it is one of the few studies in the literature.…”

“…NT is defined as the subcutaneous fluid located under the skin at the back of the fetal neck measured between 11 weeks and 13 weeks + 6 days of gestation, regardless of whether it covers only the head or whole body, or presents septations. [5] The main mechanisms suggested for increased NT are a change in the composition of the extracellular matrix, heart, great artery anomalies, and impaired or delayed lymphatic development. [3] Fetuses with increased NT are at high risk for chromosomal, structural, and genetic anomalies, and generally, it is accepted as a non-specific sign of fetal abnormality.…”

Severe smallness as predictor of adverse perinatal outcome in suspected late small‐for‐gestational‐age fetuses: systematic review and meta‐analysis

“…All HSROC curves are shown in Figure 2. Data for predicting admission to the NICU were available in 11 studies 12,[28][29][30][31][32][33][34][35][36][37] . Detection rates at 25% and 50% false-positive rates (FPRs) were 48% and 76%, respectively.…”

“…According to the QUADAS-2 scale, four articles 12,28,29,34 had high risk of bias in the patient selection domain owing to the nested case-control design of the study. One study 31 raised some concerns in terms of patient selection because of its inappropriate exclusion of participants with EFW > 90 th percentile. However, this did not necessarily increase the risk of bias in the selection of our study population.…”

İkinci trimesterde seri fetal abdominal çapın ölçümü gebelik haftasına göre düşük doğum ağırlığını ve fetal gelişim geriliğini öngörebilir mi?

“…The importance of combination of serial ultrasonographic scans, fetal doppler parameters and biochemical parameters are well documented. In a retrospective study, Hendrix et al reported that it can be better for predict of SGA combination of first trimester PAPP-A, B-hCG, PIGF, and sFlt-1 and ultrasonographic growth velocity screening between 18-22 th and 30-34 th gestational weeks than baseline screening parameters alone 23 . In another retrospective study which included 23894 singleton pregnancies scanned between 19 and 24 weeks, Familiari et al showed that combination of mid-trimester fetal biometry, uterine artery doppler indices and maternal demographics characteristics can identify the majority of pregnancies at high risk for SGA birth and showed a higher performance for earlier gestational ages at birth and lower birth-weight centiles 24 .…”