“Screening for small-for-gestational age neonates at early third trimester in a high-risk population for preeclampsia”

Abstract

Background Strategies to improve prenatal detection of small-for-gestational age (SGA) neonates are necessary because its association with poorer perinatal outcome. This study evaluated, in pregnancies with first trimester high risk of early preeclampsia, the performance of a third trimester screening for SGA combining biophysical and biochemical markers. Methods This is a prospective longitudinal study on 378 singleton pregnancies identified at high risk of early preeclampsia according to a first trimester multiparametric algorithm with the cutoff corresponding to 15% false positive rate. This cohort included 50 cases that delivered SGA neonates with birthweight < 10th centile (13.2%) and 328 cases with normal birthweight (86.8%). At 27–30 weeks’ gestation, maternal weight, blood pressure, estimated fetal weight, mean uterine artery pulsatility index and maternal biochemical markers (placental growth factor and soluble FMS-Like Tyrosine Kinase-1) were assessed. Different predictive models were created to evaluate their performance to predict SGA neonates. Results For a 15% FPR, a model that combines maternal characteristics, estimated fetal weight, mean uterine artery pulsatility index and placental growth factor achieved a detection rate (DR) of 56% with a negative predictive value of 92.2%. The area under receiver operating characteristic curve (AUC) was 0.79 (95% confidence interval (CI), 0.72–0.86). The DR of a model including maternal characteristics, estimated fetal weight and mean uterine artery pulsatility index was 54% (AUC, 0.77 (95% CI, 0.70–0.84)). The DR of a model that includes maternal characteristics and placental growth factor achieved a similar performance (DR 56%, AUC 0.75, 95% CI (0.67–0.83)). Conclusions The performance of screening for SGA neonates at early third trimester combining biophysical and biochemical markers in a high-risk population is poor. However, a high negative predictive value could help in reducing maternal anxiety, avoid iatrogenic interventions and propose a specific plan for higher risk patients.

A Review of Roles of Uterine Artery Doppler in Pregnancy Complications

“…Combining serum Split and Hairy-related Protein 1 (SHARP1), inhibin-A expressions, sFlt-1/PlGF ratio, and UAD could also enhance the screening efficacy for predicting PE ( 68 , 118 , 119 ). A recent prospective research studied 378 pregnant women with high-risk factors for early-onset PE by adopting the multivariate prediction model of early pregnancy ( 120 ). The sensitivity of predicting SGA by combining UtA-PI, PlGF, and sFlt-1 was low in the third trimester ( 120 ).…”

“…A recent prospective research studied 378 pregnant women with high-risk factors for early-onset PE by adopting the multivariate prediction model of early pregnancy ( 120 ). The sensitivity of predicting SGA by combining UtA-PI, PlGF, and sFlt-1 was low in the third trimester ( 120 ). However, a high negative predictive value can alleviate the anxiety of pregnant women, avoid unnecessary medical intervention, and formulate individualized treatment plans for high-risk groups ( 120 ).…”

“…The sensitivity of predicting SGA by combining UtA-PI, PlGF, and sFlt-1 was low in the third trimester ( 120 ). However, a high negative predictive value can alleviate the anxiety of pregnant women, avoid unnecessary medical intervention, and formulate individualized treatment plans for high-risk groups ( 120 ). The contradicting results of different studies may be due to the diverse definitions of PE and FGR, different methods of Doppler detection (pulsed, color or continuous wave), distinct diagnostic criteria of positive cases, different subjects, and the usage of aspirin and/or low molecular weight heparin (LMWH).…”

Third trimester uterine artery Doppler for prediction of adverse perinatal outcomes

“…Researchers from Spain reported a 61% detection rate for SGA when UtAPI was included in a prediction model that included the EFW, maternal characteristics and biochemical markers at 32–36 weeks of gestation [39]. Mula et al [40 ▪ ] evaluated different models for the prediction of SGA at 27–30 weeks of gestation in pregnancies previously identified as high risk for preeclampsia. The best predictor model was the combination of maternal characteristics, EFW ( z scores), mean UtAPI and PlGF with a detection rate of 56% and negative-predictive value of 92% at a fixed false positive of 15%.…”

“…Abnormal UtAD waveforms have been associated with lower gestational age at delivery and preterm birth in pregnancies complicated by FGR and HDP [35 ▪ ,40 ▪ ]. It also appears that third trimester UtAD studies have some value for the prediction of preterm delivery even in cases without complications.…”