Maternal Blood Biomarkers of Placentation toPredict Low-Birth-Weight Newborns: A Meta-Analysis.

Abstract

The development of methods for pre-delivery prediction of low-birth-weight newborns would be clinically advantageous because low birth weight contributes to a high infant mortality rate. This study was performed to examine whether maternal blood biomarkers of placentation can be used to predict low-birth-weight newborns. Ten databases, including PubMed/Medline, were searched. Any English language study that provided all of the true- and false-positive and true- and false-negative results of this prediction was included in the analysis. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies. Bivariate diagnostic meta-analysis was performed to construct hierarchical summary receiver operating characteristic curves. Based on relatively good quality studies, alpha fetoprotein (AFP), human chorionic gonadotropin (hCG), and pregnancy-associated plasma protein A (PAPP-A) (n= 73, 19, and 7, respectively) showed low sensitivity and specificity and low diagnostic odds ratio. The informational usability was categorized as "no exclusion or confirmation" (i.e., positive likelihood ratio <10 and negative likelihood ratio >0.1). The diagnostic accuracy of AFP and hCG or PAPP-A was categorized as low (i.e., 0.5 ≤ area under the curve ≤0.7) or could not be categorized (i.e., area under the curve <0.5). There is no evidence that maternal blood levels of AFP, hCG, or PAPP-A used as a single predictor are useful to predict low-birth-weight newborns.