Predictor Of Small For Gestational Age Research Articles

The correlation between placental growth factor and small for gestational age infants: a matched case-control study

Background At present, research has not found easily accessible, accurate, and safe clinical biomarkers that can effectively predict the occurrence of infants born small for gestational age (SGA). The aim of this study is to explore the predictive role of maternal placental growth factor (PIGF) levels on the occurrence of SGA infants. Method We conducted a matched case-control study on 226 SGA infants and 226 non-SGA infants born in the Department of Obstetrics, Peking University People’s Hospital, from January 2021 to December 2022, with regular monitoring of maternal serum PIGF levels in second trimester during pregnancy. Apply multiple logistic regression analysis and receiver operating characteristic (ROC) curve analysis to determine whether PIGF is an independent influencing factor for the occurrence of SGA in infants, and evaluate whether PIGF can predict the occurrence of SGA in infants. Results Multiple logistic regression analysis found that multipara (HR = 0.484, 95% CI = 0.250–0.937, p = 0.031), maternal pre-pregnancy underweight (HR = 4.710, 95% CI = 1.881–11.792, p = 0.001), pre-eclampsia(HR = 2.291, 95% CI = 1.068–4.913, p = 0.033), low levels of PIGF (HR = 26.417, 95% CI = 12.850–54.311, p < 0.001) and oligohydramnios (HR = 4.764, 95% CI = 1.845–12.301, p = 0.001) were independent factors affecting the occurrence of infants born SGA. In addition, ROC curve analysis showed that the area under the curve (AUC) predicted by PIGF level and four other influencing factors for the occurrence of SGA infants were 0.834 and 0.723, respectively. In addition, the combination of PIGF and four other independent influencing factors improved the predictive value (AUC 0.902) for the birth of SGA infants, with enhanced sensitivity and specificity. Conclusion Low levels of PIGF in second trimester during pregnancy are an independent risk factor for SGA infants. Compared with other indicators, PIGF levels PIGF in second trimester are a better predictor of SGA in infants.

Competing‐risks model for prediction of small‐for‐gestational‐age neonate from maternal characteristics, serum pregnancy‐associated plasma protein‐A and placental growth factor at 11–13 weeks' gestation

To expand a new competing-risks model for prediction of a small-for-gestational-age (SGA) neonate, by the addition of pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF), and to evaluate and compare PAPP-A and PlGF in predicting SGA. This was a prospective observational study of 60 875 women with singleton pregnancy undergoing routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation. We fitted a folded-plane regression model for the PAPP-A and PlGF likelihoods. A previously developed maternal history model and the likelihood models were combined, according to Bayes' theorem, to obtain individualized distributions for gestational age (GA) at delivery and birth-weight Z-score. We assessed the discrimination and calibration of the model. McNemar's test was used to compare the detection rates for SGA with, without or independently of pre-eclampsia (PE) occurrence, of different combinations of maternal history, PAPP-A and PlGF, for a fixed false-positive rate. The distributions of PAPP-A and PlGF depend on both GA at delivery and birth-weight Z-score, in the same continuous likelihood, according to a folded-plane regression model. The new approach offers the capability for risk computation for any desired birth-weight Z-score and GA at delivery cut-off. PlGF was consistently and significantly better than PAPP-A in predicting SGA delivered before 37 weeks, especially in cases with co-existence of PE. PAPP-A had similar performance to PlGF for the prediction of SGA without PE. At a fixed false-positive rate of 10%, the combination of maternal history, PlGF and PAPP-A predicted 33.8%, 43.8% and 48.4% of all cases of a SGA neonate with birth weight < 10th percentile delivered at ≥ 37, < 37 and < 32 weeks' gestation, respectively. The respective values for birth weight < 3rd percentile were 38.6%, 48.7% and 51.0%. The new model performed well in terms of risk calibration. The combination of PAPP-A and PlGF values with maternal characteristics, according to Bayes' theorem, improves prediction of SGA. PlGF is a better predictor of SGA than PAPP-A, especially when PE is present. The new competing-risks model for SGA can be tailored to each pregnancy and to the relevant clinical requirements. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Quad test for fetal aneuploidy screening as a predictor of small-for-gestational age fetuses: a population-based study

BackgroundTo identify the relationship between quadruple test for aneuploidy screening (alpha-fetoprotein: AFP; free beta-human chorionic gonadotropin: b-hCG; unconjugated estriol: uE3 and inhibin-A: IHA) and fetal growth restriction and to construct predictive models for small-for-gestational-age (SGA) fetuses.MethodsWomen who underwent quadruple test for aneuploidy were followed-up for final outcomes. The multiples of the median (MoMs) of the four biochemical markers for the SGA group and those of normal fetuses were compared. The models for predicting SGA by the individual biomarkers and their combination were constructed using binary logistic regression analysis, and their diagnostic performances in predicting SGA were determined.ResultsOf 10,155 eligible pregnant women, 578 (5.7%) and 9577 (94.3%) had SGA and normal growth, respectively. High levels of AFP, b-hCG and IHA but low levels of uE3 significantly increased the risk of SGA. The constructed predictive equations had predictive performance for SGA, with areas under the receiver-operated characteristic curve of 0.724, 0.655, 0.597, 0.664 and 0.754 for AFP, b-hCG, uE3, IHA, and the combination, respectively.ConclusionThe quad test for aneuploidy screening could also be used as a predictor of SGA, without extra-effort and extra-cost.

P04.04: Compensatory dilatation of umbilical arterial diameter in isolated single umbilical artery

The aim of this study is to evaluate differences of umbilical arterial diameter (UmAD) and Doppler velocimetry on umbilical artery between fetuses with isolated single umbilical artery (iSUA) and fetuses with three vessel cord (TVC). We retrospectively reviewed 118 cases of ultrasonographic exam of fetuses from 28 to 32 weeks of gestation with a prenatally identified iSUA and without congenital malformation retrospectively, who are delivered in Severance Hospital, Yonsei University Health System. UmAD and Doppler velocimetry including presystolic velocity, end-diastolic velocity, RI, and systolic-diastolic ratio on umbilical artery of both group were reviewed. Thirty fetuses with prenatally identified iSUA were enrolled and twelve fetuses was revealed small-for-gestational age (SGA) after delivery. Eleven out of ninety fetuses without any congenital malformation were confirmed in SGA after delivery. Doppler velocimetry didn't make differences in both group. However, significant difference of UmAD was apparent between iSUA group and TVC group. UmAD in iSUA group without SGA is significantly greatest comparing with iSUA with SGA group, TVC with or without SGA groups. In iSUA group, 3.45 mm of UmAD had 76.5 % of sensitivity and 91.7 % of specificity to predict SGA. Normal fetuses with iSUA are at higher risk to be born as SGA. With our study results we can confirm the hypothesis that compensatory dilatation of umbilical arterial diameter in fetuses with iSUA while Doppler velocimetry doesn't have significant differences between iSUA and 3VC group. And UmAD could be a useful predictor of SGA with fetuses with iSUA.

Added value of cerebro-placental ratio and uterine artery Doppler at routine third trimester screening as a predictor of SGA and FGR in non-selected pregnancies

Objectives: The objective of this study is to determine the added value of cerebroplacental ratio (CPR) and uterine Doppler velocimetry at third trimester scan in an unselected obstetric population to predict smallness and growth restriction.Methods: We constructed a prospective cohort study of women with singleton pregnancies attended for routine third trimester screening (32+0–34+6 weeks). Fetal biometry and fetal–maternal Doppler ultrasound examinations were performed by certified sonographers. The CPR was calculated as a ratio of the middle cerebral artery to the umbilical artery pulsatility indices. Both attending professionals and patients were blinded to the results, except in cases of estimated fetal weight < p10. The association between third trimester Doppler parameters and small for gestational age (SGA) (birth weight <10th centile) and fetal growth restriction (FGR) (birth weight below the third centile) was assessed by logistic regression, where the basal comparison was a model comprising maternal characteristics and estimated fetal weight (EFW).Results: A total of 1030 pregnancies were included. The mean gestational age at scan was 33 weeks (SD 0.6). The addition of CPR and uterine Doppler to maternal characteristics plus EFW improved the explained uncertainty of the predicting models for SGA (15 versus 10%, p < .001) and FGR (12 versus 8%, p = .03). However, the addition of CPR and uterine Doppler to maternal characteristics plus EFW only marginally improved the detection rates for SGA (38 versus 34% for a 10% of false positives) and did not change the predictive performance for FGR.Conclusions: The added value of CPR and uterine Doppler at 33 weeks of gestation for detecting defective growth is poor.

EP14.17: Fetal abdominal circumference in the second trimester and prediction of small‐for‐gestational age at birth

Infants that are small for gestational age (SGA) at birth are at increased risk for morbidity and mortality. However, the antenatal prediction of SGA is suboptimal. We sought to: 1. Examine the association between 2nd trimester fetal abdominal circumference <10% (2T-AClag) and SGA and other gestational and neonatal complications; 2. Assess 2T-AClag as a predictor of SGA. A retrospective study of 212 singleton gestations with 2T-AClag on routine ultrasound between 18-24 weeks. The study group was compared to 424 gestations without 2T-AClag for maternal characteristics, pregnancy and neonatal complications. A multivariate logistic regression was used to determine the predictive value of 2T-AClag for SGA, adjusting for maternal and pregnancy characteristics. The screening model accuracy was assessed through ROC curves. Gestations with 2T-AClag had higher rates of SGA (35.7 vs 11.6%, p<0.0001), IUGR (17% vs 1.7%, p<0.0001), pregnancy induced hypertension (31.1% vs 17%, p<0.0001), pre-eclampsia (14.6% vs 7.8%, 0=0.01), abnormal umbilical artery Doppler (30% vs 5.1%, p<0.0001), indicated preterm birth (5.7% vs 1.9%, p=0.01), primary Caesarean birth (29.6% vs 20.1%, p=0.01) and NICU admissions (12.9% vs 6.4%, p=0.009). After adjusting for maternal and gestational risk factors, 2T-AClag remained an independent risk factor for SGA (OR 4.53, 95%CI 2.91-7.05, p<0.0001) and IUGR (OR 11.57, 95%CI 5.02-26.65, p<0.0001). The inclusion of 2T-AClag in a regression model with traditional risk factors, significantly improved the model's predictability for SGA and IUGR (area under ROC curve increased from 0.618 to 0.723 and 0.653 to 0.819, respectively, p<0.0001). A finding of AC lag at time of 2nd trimester ultrasound is associated with an increased risk of SGA, IUGR and other adverse outcomes. The inclusion of 2T-AClag in a screening model for prediction of SGA and IUGR may improve the identification of this at risk group and assist in customising the surveillance plan.

Second-Trimester 3-Dimensional Placental Sonography as a Predictor of Small-for-Gestational-Age Birth Weight.

We previously reported the association between first-trimester 3-dimensional (3D) placental measurements and small-for-gestational-age (SGA) neonates. In this study, we sought to determine whether second-trimester measurements further contribute to the antenatal detection of SGA and preeclampsia. We prospectively collected 3D sonographic volume sets and uterine artery pulsatility indices of singleton pregnancies at 18 to 24 weeks. Placental volume, placental quotient (placental volume/gestational age), mean placental diameter and chorionic diameter, placental morphologic index (mean placental diameter/placental quotient), placental chorionic index (mean chorionic diameter/placental quotient), and placental growth (volume per week) were assessed and evaluated as predictors of SGA and preeclampsia as a composite and alone. Of 373 pregnancies, the composite outcome occurred in 67 (18.0%): 36 (9.7%) manifested SGA alone; 27 (7.2%) developed preeclampsia alone, and 4 (1.1%) developed both. The placental volume, placental quotient, mean placental diameter, mean chorionic diameter, and volume per week were significantly smaller, whereas the placental morphologic index and chorionic index were significantly larger in pregnancies with the composite outcome (P < .01). Further analyses revealed that the significant associations with placental parameters were limited to the SGA outcome. Each placental measure remained significantly associated with SGA after adjusting for confounders. The mean uterine artery pulsatility index was not associated with either outcome. Placental parameters were moderately predictive of SGA, with adjusted areas under the curve ranging from 0.72 to 0.76. Sensitivity for detection of SGA ranged from 32.5% to 45.0%, with positive predictive values ranging from 17.3% to 22.7%. Second-trimester 3D placental measurements can identify pregnancies at risk of SGA. However, there appears to be no significant improvement compared to those obtained in the first trimester.

The association between second trimester estimated fetal weight and small for gestational age at birth

Objective: To analyze diagnostic accuracy of second trimester ultrasound fetal growth parameters as predictors of small for gestational age (SGA) birth weight. Methods: We reviewed the fetal biometry from 714 consecutive patients with second trimester ultrasounds. The estimated fetal weight (EFW) and abdominal circumference (AC) percentiles were tested as predictors of SGA at birth (<10‰). Results: 87 (12.2%) patients had an SGA baby. Patients with a second trimester EFW ≤25‰ were significantly more likely to have SGA at birth (24.2% versus 10.3%, p < 0.001). Similar results were seen for women with second trimester AC ≤25‰ (likelihood of SGA 21.9% versus 11.2%, p = 0.013). A second trimester EFW ≤25‰ was a better predictor of SGA at birth than a second trimester EFW ≤ 10‰ (Positive likelihood ratio 2.30 versus 2.09). In the second trimester, only 9 (1.3%) patients had an EFW 0–10‰, only 43 (6%) patients had an EFW 11–20‰, and only 46 (6.4%) patients had an EFW 91–99‰. Each other EFW centile had more than 10% of the patients. Conclusions: The incidence of second trimester EFW or AC ≤10‰ is less common than expected from standard tables. An EFW ≤25‰ and an AC ≤25‰ should be considered the second trimester marker for risk of SGA at birth. However, due to the low likelihood ratio of, it is not clear if second trimester ultrasound should be used as a predictor of SGA at birth.

Eliminating first trimester markers: will replacing PAPP-A and βhCG miss women at risk for small for gestational age?

Objective: Placental analytes are traditionally used for aneuploidy screening, although may be replaced by cell-free fetal DNA. Abnormal analytes also identify women at risk for small for gestational age (SGA). We sought to quantify the proportion of women at risk for SGA by low pregnancy-associated plasma protein-A (PAPP-A) or βhCG who would not otherwise be identified by maternal risk factors.Methods: We studied first-trimester PAPPA-A and βhCG from 658 euploid singleton pregnancies from a prospective longitudinal cohort. Analytes were standardized for gestational age in multiples of the median (MoM). SGA was defined as birthweight z-score ≤−1.28. Maternal risk factors included chronic hypertension, pre-gestational diabetes and age ≥40.Results: Mean GA was 38.8 ± 1.9 weeks; 6.8% had a SGA infant. Low PAPP-A and βhCG were identified in 48 (7.4%) and 9 (1.4%) of pregnancies, respectively, of whom 18.9% were SGA (OR 3.0, 95% CI 1.4–6.3). 88% did not have risk factors for SGA. Among women with no risk factors, low PAPP-A was a significant predictor of SGA (OR 3.3, 95% CI 1.5–7.4).Conclusion: Most women with abnormal analytes did not have risk factors for SGA. Eliminating PAPP-A and βhCG may present missed opportunities to identify women at risk for SGA.

An evaluation of clinical estimation of fetal weight and symphysis fundal distance for detection of SGA infants

In 58 small for gestational age (SGA) infants and 141 non-SGA infants, the measuring of symphysis fundal distance (SF) was compared with clinical estimation of fetal weight in order to evaluate the efficacy of the two methods of predicting SGA. By regression analyses, the SF curve deviation explains 22% of the variation of birthweight. The estimated fetal weight (EFW) curve deviation explains 40%. By combining the two values, 42% of the variation in birthweight is explained. When receiver operating characteristic (ROC) curve analyses, Kappa index and relative risk were applied the clinical estimation of fetal weight by abdominal palpation was found to be as reliable a predictor of SGA at birth as the measurement of the SF distance. Statistical analyses of the SF curve and EFW curve do not improve the results compared with the last measurement of SF distance and EFW. Combination of the EFW and SF measurements results in a higher sensitivity (one test positive) or a higher predictive value (both tests positive). Only marginal additional diagnostic information was achieved, however, as the ROC curves, Kappa index and Relative risk were nearly unchanged, regardless of combination of EFW and SF measurements.