Prediction of small-for-gestational-age neonates: screening by biophysical and biochemical markers at 30-34 weeks

Bakalis, Spyros; Peeva, Gergana; Gonzalez, Ricardo; Poon, Liona C.; Nicolaides, Kypros H.

doi:10.1002/uog.14863

Cited by 44 publications

(61 citation statements)

References 30 publications

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“…The authors reported an 89% detection rate for SGA newborns with a 10% false positive rate, combining maternal characteristics, obstetric history, and fetal biometric measurements. Bakalis et al [36] reported a 65% detection rate of SGA (<5 th centile) neonates with delivery at ≥37 weeks when the EFW assessed at 30–34 weeks was combined with maternal factors, uterine artery PI, mean arterial pressure, and serum placental growth factor. The results described herein for single biometry at ≤32 weeks in a mostly African-American population are in very good agreement with these previous findings as we report about a 50% sensitivity for both SGA (<5 th centile) and LGA (>95 th centile) prediction (FPR = 10%).…”

Section: Discussionmentioning

confidence: 99%

Single and Serial Fetal Biometry to Detect Preterm and Term Small- and Large-for-Gestational-Age Neonates: A Longitudinal Cohort Study

et al. 2016

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ObjectivesTo assess the value of single and serial fetal biometry for the prediction of small- (SGA) and large-for-gestational-age (LGA) neonates delivered preterm or at term.MethodsA cohort study of 3,971 women with singleton pregnancies was conducted from the first trimester until delivery with 3,440 pregnancies (17,334 scans) meeting the following inclusion criteria: 1) delivery of a live neonate after 33 gestational weeks and 2) two or more ultrasound examinations with fetal biometry parameters obtained at ≤36 weeks. Primary outcomes were SGA (<5th centile) and LGA (>95th centile) at birth based on INTERGROWTH-21st gender-specific standards. Fetus-specific estimated fetal weight (EFW) trajectories were calculated by linear mixed-effects models using data up to a fixed gestational age (GA) cutoff (28, 32, or 36 weeks) for fetuses having two or more measurements before the GA cutoff and not already delivered. A screen test positive for single biometry was based on Z-scores of EFW at the last scan before each GA cut-off so that the false positive rate (FPR) was 10%. Similarly, a screen test positive for the longitudinal analysis was based on the projected (extrapolated) EFW at 40 weeks from all available measurements before each cutoff for each fetus.ResultsFetal abdominal and head circumference measurements, as well as birth weights in the Detroit population, matched well to the INTERGROWTH-21st standards, yet this was not the case for biparietal diameter (BPD) and femur length (FL) (up to 9% and 10% discrepancy for mean and confidence intervals, respectively), mainly due to differences in the measurement technique. Single biometry based on EFW at the last scan at ≤32 weeks (GA IQR: 27.4–30.9 weeks) had a sensitivity of 50% and 53% (FPR = 10%) to detect preterm and term SGA and LGA neonates, respectively (AUC of 82% both). For the detection of LGA using data up to 32- and 36-week cutoffs, single biometry analysis had higher sensitivity than longitudinal analysis (52% vs 46% and 62% vs 52%, respectively; both p<0.05). Restricting the analysis to subjects with the last observation taken within two weeks from the cutoff, the sensitivity for detection of LGA, but not SGA, increased to 65% and 72% for single biometry at the 32- and 36-week cutoffs, respectively. SGA screening performance was higher for preterm (<37 weeks) than for term cases (73% vs 46% sensitivity; p<0.05) for single biometry at ≤32 weeks.ConclusionsWhen growth abnormalities are defined based on birth weight, growth velocity (captured in the longitudinal analysis) does not provide additional information when compared to the last measurement for predicting SGA and LGA neonates, with both approaches detecting one-half of the neonates (FPR = 10%) from data collected at ≤32 weeks. Unlike for SGA, LGA detection can be improved if ultrasound scans are scheduled as close as possible to the gestational-age cutoff when a decision regarding the clinical management of the patient needs to be made. Screening performance for SGA is higher for neonates that will...

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Section: Discussionmentioning

confidence: 99%

Single and Serial Fetal Biometry to Detect Preterm and Term Small- and Large-for-Gestational-Age Neonates: A Longitudinal Cohort Study

et al. 2016

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“…Alternatively, earlier GA at sampling may explain the lack of association, as angiogenic imbalance is likely to be progressive. More recently, a large prospective study conducted at 30-34 weeks' gestation concluded that a combined screening, including maternal factors, EFW, UtA-PI, MAP and serum PlGF without inclusion of sFlt-1 can predict at 10% false-positive rate, 57% of SGA neonates delivering at ≥37 weeks with a birth weight <10th percentile [49]. …”

Section: Discussionmentioning

confidence: 99%

Angiogenic Factors and Doppler Evaluation in Normally Growing Fetuses at Routine Third-Trimester Scan: Prediction of Subsequent Low Birth Weight

et al. 2015

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Objective: To evaluate in normally growing fetuses at routine 32-36 weeks scan the performance of maternal angiogenic factors, Doppler and ultrasound indices in predicting smallness for gestational age (SGA) at birth. Methods: A cohort of 1,000 singleton pregnancies with normal estimated fetal weight (EFW, ≥10th centile) at 32-36 weeks scan was included. At inclusion, Doppler indices (mean uterine artery pulsatility index [mUtA-PI], cerebroplacental ratio and normalized umbilical vein blood flow by EFW (ml/min/kg) were evaluated, and blood samples were collected and frozen. Nested in this cohort, maternal circulating placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were assayed by enzyme-linked immunosorbent assay in all cases with a birth weight <10th centile by customized standards and in an equivalent number of controls (birth weight ≥10th centile). Results: 160 cases were included (80 SGA and 80 controls). EFW (2,128 vs. 2,279 g, p < 0.001), mUtA-PI z-values (-0.25 vs. -0.65, p = 0.034) and sFlt-1/PlGF ratio (11.10 vs. 6.74, p < 0.005) were lower in SGA. The combination of sFlt-1/PlGF ratio and EFW resulted in a 66.3% detection rate for subsequent SGA, with 20% of false-positives. Fetal Doppler indices were not predictive of SGA. Conclusions: In normally growing fetuses, maternal angiogenic factors add to ultrasound parameters in predicting subsequent SGA at birth. This supports further research to investigate composite scores in order to improve the definition and identification of fetal growth restriction.

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“…Impaired placentation, reflected in increased pulsatility index (PI) in the uterine arteries (UtAs), reduced serum placental growth factor (PlGF) and increased soluble fms‐like tyrosine kinase‐1 (sFlt‐1) is associated with subsequent development of pre‐eclampsia (PE) and delivery of a small‐for‐gestational‐age (SGA) neonate. Another marker of development of PE is increased mean arterial pressure (MAP). Impaired placentation is also associated with fetal hypoxemia and consequent redistribution in the fetal circulation, reflected in reduced fetal middle cerebral artery (MCA) PI and increased UA‐PI.…”

Section: Introductionmentioning

confidence: 99%

Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome

Valiño

Giunta

Gallo

et al. 2016

Ultrasound Obstet Gynecol

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Prediction of small-for-gestational-age neonates: screening by biophysical and biochemical markers at 30-34 weeks

Abstract: ABSTRACT

Cited by 44 publications

References 30 publications

Single and Serial Fetal Biometry to Detect Preterm and Term Small- and Large-for-Gestational-Age Neonates: A Longitudinal Cohort Study

Single and Serial Fetal Biometry to Detect Preterm and Term Small- and Large-for-Gestational-Age Neonates: A Longitudinal Cohort Study

Angiogenic Factors and Doppler Evaluation in Normally Growing Fetuses at Routine Third-Trimester Scan: Prediction of Subsequent Low Birth Weight

Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome

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