Abstract
BackgroundStrategies 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.MethodsThis 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.ResultsFor 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)).ConclusionsThe 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.
Highlights
Strategies to improve prenatal detection of small-for-gestational age (SGA) neonates are necessary because its association with poorer perinatal outcome
The aim of our study was to evaluate, in a subgroup of women classified as high risk of early preeclampsia using a first trimester multiparametric algorithm, the performance of a contingent third trimester screening for SGA combining maternal characteristics, uterine Doppler, fetal biometry, mean arterial pressure and biochemical markers
Quantitative variables were expressed as mean ± SD (*p < 0.05) SGA Small-for-gestational age neonates, Uterine artery pulsatility index (PI) Pulsatility index, MoM Multiples of the median, MAP Mean arterial pressure, pregnancy-associated plasma protein A (PAPP-A) Pregnancy-associated plasma protein A, placental growth factor (PlGF) Placental growth factor, estimated fetal weight (EFW) Estimated fetal weight, soluble FMS-Like Tyrosine Kinase-1 (sFlt-1) Soluble FMS-Like Tyrosine Kinase-1 neonates (DR of 56%, area under receiver operating characteristic curve (AUC) of 0.75 95% confidence interval (CI), 0.67–272 0.83 (FPR 15%)) (Table 4)
Summary
Strategies to improve prenatal detection of small-for-gestational age (SGA) neonates are necessary because its association with poorer perinatal outcome. Some studies have evaluated third trimester strategies incorporating maternal parameters and placental biomarkers and their improvement in the detection rate of SGA fetuses in the absence of preeclampsia [11,12,13]. Since most of these studies are based in general population and the two conditions share pathophysiological mechanisms, is interesting to evaluate the risk of SGA neonates in a subgroup of patients identified at high risk of PE early in the pregnancy
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