Prediction of small-for-gestational-age neonates: screening by biophysical and biochemical markers at 19-24 weeks

Poon, Liona C.; Heredia, Cristina Lesmes; Gallo, Dahiana; Akolekar, Ranjit; Nicolaides, Kypros H.

doi:10.1002/uog.14904

Cited by 56 publications

(44 citation statements)

References 19 publications

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“…The same group of investigators performed other studies in which sequential biophysical and biochemical screening, including uterine artery Doppler studies, and maternal mean arterial pressure were performed at 19 to 24 weeks and 32 to 36 weeks gestation to successfully predict a high proportion of SGA neonates. 13,25 Unfortunately, the combination of uterine artery Doppler studies with maternal clinical risk factors and serum biomarkers might be a prohibitive undertaking that limits its clinical applicability. Our study is different from previous studies in the following ways: 1) an unselected, general obstetrical population was recruited from multiple centers across the US; 2) appropriate cutoffs were determined for three different uterine artery measurements (diastolic notching, RI, and PI); 3) bilateral studies were performed in all patients, and the more abnormal result was used in the analyses, since uterine artery flow may be lower contralateral to placental location; 4) four outcomes were studied – SGA, gestational hypertension/preeclampsia, spontaneous preterm birth, and stillbirth; and 5) the analyses focused on the most clinically relevant aspects of the uterine artery studies – positive predictive values, areas under ROC curves, and likelihood ratios.…”

Section: Commentmentioning

confidence: 99%

“…3,9–13 In particular, models for predicting preeclampsia utilizing maternal clinical features, uterine artery Doppler studies, and maternal serum biomarkers are promising but may be too complex for widespread clinical application. 9,13,14 In one large retrospective cohort, uterine artery PI was able to predict 25 to 77 percent of growth-restricted babies delivering at various gestational ages at a ten percent false-positive rate, 15 while another observational study using biophysical (i.e., uterine artery Doppler studies) and biochemical markers at 19 to 24 weeks reported detection rates ranging from 100 to 42 percent for small for gestational age (SGA) neonates delivered before 32 weeks to greater than or equal to 37 weeks gestation, respectively. 13 However, the predictive value of uterine artery Doppler testing in unselected groups of pregnant women appears to be low in systematic reviews of previous studies.…”

Section: Introductionmentioning

confidence: 99%

“…9,13,14 In one large retrospective cohort, uterine artery PI was able to predict 25 to 77 percent of growth-restricted babies delivering at various gestational ages at a ten percent false-positive rate, 15 while another observational study using biophysical (i.e., uterine artery Doppler studies) and biochemical markers at 19 to 24 weeks reported detection rates ranging from 100 to 42 percent for small for gestational age (SGA) neonates delivered before 32 weeks to greater than or equal to 37 weeks gestation, respectively. 13 However, the predictive value of uterine artery Doppler testing in unselected groups of pregnant women appears to be low in systematic reviews of previous studies. 3,9,10,16 Despite these conflicting data, many obstetricians continue to perform multiple Doppler studies of maternal and fetal vessels, including uterine artery Doppler studies, to identify women at risk of adverse pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women

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Haas

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. Objective To determine the utility of early second trimester uterine artery Doppler studies as a predictor of small for gestational age (SGA) neonates. Study Design Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at eight institutions across the United States. Participants were seen at three study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days and 22 weeks 6 days gestation. Test characteristics for varying thresholds in the prediction of SGA (defined as birth weight <5th percentile for gestational age [Alexander growth curve]) were evaluated. Results Uterine artery Doppler indices, birth weight, and gestational age at birth were available for 8,024 women. Birth weight <5th percentile for gestational age occurred in 358 (4.5 percent) of the births. Typical thresholds for the uterine artery Doppler indices were all associated with birth weight <5th percentile for gestational age (P<0.0001 for each), but the positive predictive values for these cutoffs were all <15 percent and areas under receiver operating characteristic curves (AUCs) ranged from 0.50 to 0.60. Across the continuous scales for these measures, the AUCs ranged from 0.56 to 0.62. Incorporating maternal age, early pregnancy BMI, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pre-gestational diabetes in the prediction model resulted in only modest improvements in the AUCs ranging from 0.63 to 0.66. Conclusion In this large prospective cohort, early second trimester uterine artery Doppler studies were not a clinically useful test for predicting SGA babies.

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Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women

Parry

Sciscione

Haas

et al. 2017

American Journal of Obstetrics and Gynecology

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“…[55] An algorithm whereby women who have moderate or high risk screening for SGA at 19–24 weeks are selectively offered further third trimester scanning at 32 and or 36 weeks has been proposed and now requires validation. [56]…”

Section: Discussionmentioning

confidence: 99%

Prediction of Small for Gestational Age Infants in Healthy Nulliparous Women Using Clinical and Ultrasound Risk Factors Combined with Early Pregnancy Biomarkers

et al. 2017

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ObjectiveMost small for gestational age pregnancies are unrecognised before birth, resulting in substantial avoidable perinatal mortality and morbidity. Our objective was to develop multivariable prediction models for small for gestational age combining clinical risk factors and biomarkers at 15±1 weeks’ with ultrasound parameters at 20±1 weeks’ gestation.MethodsData from 5606 participants in the Screening for Pregnancy Endpoints (SCOPE) cohort study were divided into Training (n = 3735) and Validation datasets (n = 1871). The primary outcomes were All-SGA (small for gestational age with birthweight <10th customised centile), Normotensive-SGA (small for gestational age with a normotensive mother) and Hypertensive-SGA (small for gestational age with an hypertensive mother). The comparison group comprised women without the respective small for gestational age phenotype. Multivariable analysis was performed using stepwise logistic regression beginning with clinical variables, and subsequent additions of biomarker and then ultrasound (biometry and Doppler) variables. Model performance was assessed in Training and Validation datasets by calculating area under the curve.Results633 (11.2%) infants were All-SGA, 465(8.2%) Normotensive-SGA and 168 (3%) Hypertensive-SGA. Area under the curve (95% Confidence Intervals) for All-SGA using 15±1 weeks’ clinical variables, 15±1 weeks’ clinical+ biomarker variables and clinical + biomarkers + biometry /Doppler at 20±1 weeks’ were: 0.63 (0.59–0.67), 0.64 (0.60–0.68) and 0.69 (0.66–0.73) respectively in the Validation dataset; Normotensive-SGA results were similar: 0.61 (0.57–0.66), 0.61 (0.56–0.66) and 0.68 (0.64–0.73) with small increases in performance in the Training datasets. Area under the curve (95% Confidence Intervals) for Hypertensive-SGA were: 0.76 (0.70–0.82), 0.80 (0.75–0.86) and 0.84 (0.78–0.89) with minimal change in the Training datasets.ConclusionModels for prediction of small for gestational age, which combine biomarkers, clinical and ultrasound data from a cohort of low-risk nulliparous women achieved modest performance. Incorporation of biomarkers into the models resulted in no improvement in performance of prediction of All-SGA and Normotensive-SGA but a small improvement in prediction of Hypertensive-SGA. Our models currently have insufficient reliability for application in clinical practice however, they have potential utility in two-staged screening tests which include third trimester biomarkers and or fetal biometry.

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“…The maternal-fetal Doppler evaluation conducted at 20–24 weeks of gestation is not universally accepted; however, available reports show that a mean UtA-PI >95 th percentile at this gestational age can identify women at risk of preeclampsia and of SGA 39,69 . The evaluation of two additional fetal Doppler parameters, the UA and the MCA, in combination with the EFW can improve the identification of fetuses at a higher risk of reduced size later in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

A Low Cerebroplacental Ratio at 20-24 Weeks of Gestation Can Predict Reduced Fetal Size Later in Pregnancy or at Birth

et al. 2017

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Aim: To determine whether Doppler evaluation at 20-24 weeks of gestation can predict reduced fetal size later in pregnancy or at birth. Methods: Fetal biometry and Doppler velocimetry were performed in 2,986 women with a singleton pregnancy at 20-24 weeks of gestation. Predictive performances of the umbilical artery pulsatility index (UA-PI) or the mean uterine artery pulsatility index (UtA-PI) >95th percentile, middle cerebral artery pulsatility index, or cerebroplacental ratio (CPR) <5th percentile for early small for gestational age (SGA; <34 weeks of gestation), late SGA (≥34 weeks of gestation), or SGA at birth (birthweight <10th percentile) were analyzed. Results: The prevalence of early SGA, late SGA, and SGA at birth was 1.1, 9.6, and 14.7%, respectively. A CPR <5th percentile had a positive likelihood ratio (LR+) of 8.2 (95% confidence interval [CI] 5.7-12.0) for early SGA, a LR+ of 1.6 (95% CI 1.1-1.2) for late SGA, and a LR+ of 1.9 (95% CI 1.4-2.6) for SGA at birth. A UtA-PI >95th percentile was associated with late SGA and SGA at birth, while an UA-PI >95th percentile was associated with early SGA. Associations were higher in fetuses with an estimated fetal weight <10th percentile. Conclusion: Fetal biometry and Doppler evaluation at 20-24 weeks of gestation can predict early and late SGA as well as SGA at birth.

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Prediction of small-for-gestational-age neonates: screening by biophysical and biochemical markers at 19-24 weeks

Abstract: ABSTRACT

Cited by 56 publications

References 19 publications

Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women

Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women

Prediction of Small for Gestational Age Infants in Healthy Nulliparous Women Using Clinical and Ultrasound Risk Factors Combined with Early Pregnancy Biomarkers

A Low Cerebroplacental Ratio at 20-24 Weeks of Gestation Can Predict Reduced Fetal Size Later in Pregnancy or at Birth

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