Prediction study of late-onset fetal growth restriction with estimated fetal weight and Doppler parameters

Abstract

Objective To explore the predictive accuracy of two estimated fetal weight (EFW) standards (INTERGROWTH and Hadlock) and Doppler parameters for late-onset fetal growth restriction (FGR). Methods A prospective cohort of women with singleton pregnancies who attended research scans and had a livebirth at the obstetrics and gynecology hospital of Fudan University during 32-41 weeks of gestation was involved. The markers of ultrasound examinations (including growth measurements, umbilical artery and middle cerebral artery parameters) were obtained every two weeks. The INTERGROWTH-EFWc and Hadlock-EFWc data were obtained from the last ultrasonography (within 7 days before delivery) and were used to predict later-onset FGR in a single model or in combined models with other Doppler parameters by logistic regression analyses, respectively. According to delivery gestation of age and Chinese birth weight (BW) standards, all cases were divided into a control group (non-FGR, BW≥ 10th%) and a FGR group (Late-onset FGR, BW<10th%). ROC curve analyses were performed to compare the predictive accuracy for the late-onset FGR between the Hadlock-EFWc and INTERGROWTH-EFWc. Results A total of 820 eligible women were identified and 676 had finished the follow-up and were enrolled in this prospective cohort study. Among them, 116 neonates were assigned to the late-onset FGR group, and 560 as control group (non-FGR). The cut-off value of the INTERGROWTH-EFWc was percentile 27.5, at which had a sensitivity and specificity of 71.4% and 83.7%. The corresponding sensitivity and specificity were 87.3% and 82.8% at a cut-off value of percentile 22.6 of the Hadlock-EFWc. The Hadlock-EFWc had a higher predictive accuracy for the late-onset FGR than the INTERGROWTH-EFWc, their AUC were 0.930 (0.908-0.953) and 0.847 (0.807-0.888), respectively. The accuracy of Doppler single-parameter (umbilical artery and middle cerebral artery) for late-onset FGR were low (AUC<0.7), but the accuracy of combined model-Ⅰ and Ⅱ were high (AUC 0.865 and 0.936, respectively), similar to their corresponding EFWc models, respectively. Conclusions The INTERGROWTH-EFWc could predict effectively for late-onset FGR, however, its predictive accuracy is lower than that of the Hadlock-EFWc. The predictive accuracy of Doppler parameters for late-onset FGR are poor, routine monitoring of non-selected populations is not recommended. Key words: Ultrasonography; Fetal growth restriction; Small for gestational age; Estimated fetal weight; INTERGROWTH standard; Hadlock standard