Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimester

Objectives To compare the performance of third-trimester screening, based on estimated fetal weight centile (EFWc) vs a combined model including maternal baseline characteristics, fetoplacental ultrasound and maternal biochemical markers, for the prediction of small-for-gestational-age (SGA) neonate...

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Autores: Miranda J, Rodriguez-Lopez M, Triunfo S, Sairanen M, Kouru H, Parra-Saavedra M, Crovetto F, Figueras F, Crispi F, Gratacos E
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:2017
País:España
Recursos:Fundació Sant Joan de Déu
Repositório:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
OAI Identifier:oai:fsjd.fundanetsuite.com:p10635
Acesso em linha:https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=10635
Access Level:Acceso aberto
Palavra-chave:estimated fetal weight
fetal biometry
fetal growth restriction
screening
small-for-gestational age
third-trimester screening
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spelling Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimesterMiranda JRodriguez-Lopez MTriunfo SSairanen MKouru HParra-Saavedra MCrovetto FFigueras FCrispi FGratacos Eestimated fetal weightfetal biometryfetal growth restrictionscreeningsmall-for-gestational agethird-trimester screeningObjectives To compare the performance of third-trimester screening, based on estimated fetal weight centile (EFWc) vs a combined model including maternal baseline characteristics, fetoplacental ultrasound and maternal biochemical markers, for the prediction of small-for-gestational-age (SGA) neonates and late-onset fetal growth restriction (FGR). Methods This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester (32+0 to 36+6 weeks' gestation) evaluation. Maternal baseline characteristics, mean arterial pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently delivered a SGA neonate (n=175), defined as birth weight < 10th centile according to customized standards, and in a control group (n=875). Among SGA cases, those with birth weight < 3rd centile and/or abnormal uterine artery pulsatility index (UtA-PI) and/or abnormal cerebroplacental ratio (CPR) were classified as FGR. Logistic regression predictive models were developed for SGA and FGR, and their performance was compared with that obtained using EFWc alone. Results In SGA cases, EFWc, CPR Z-score and maternal serum concentrations of unconjugated estriol and PlGF were significantly lower, while mean UtA-PI Z-score and lipocalin-2 and inhibin A concentrations were significantly higher, compared with controls. Using EFWc alone, 52% (area under receiver-operating characteristics curve (AUC), 0.82 (95% CI, 0.77-0.85)) of SGA and 64% (AUC, 0.86 (95% CI, 0.81-0.91)) of FGR cases were predicted at a 10% false-positive rate. A combined screening model including a-priori risk (maternal characteristics), EFWc, UtA-PI, PlGF and estriol (with lipocalin-2 for SGA) achieved a detection rate of 61% (AUC, 0.86 (95% CI, 0.83-0.89)) for SGA cases and 77% (AUC, 0.92 (95% CI, 0.88-0.95)) for FGR. The combined model for the prediction of SGA and FGR performed significantly better than did using EFWc alone (P < 0.001 and P=0.002, respectively). Conclusions A multivariable integrative model of maternal characteristics, fetoplacental ultrasound and maternal biochemical markers modestly improved the detection of SGA and FGR cases at 32-36 weeks' gestation when compared with screening based on EFWc alone. Copyright (C) 2016 ISUOG. Published by John Wiley & Sons Ltd.WILEY2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=10635ULTRASOUND IN OBSTETRICS & GYNECOLOGYISSN: 09607692ISSNe: 14690705reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déuinstname:Fundació Sant Joan de DéuInglésinfo:eu-repo/semantics/openAccessoai:fsjd.fundanetsuite.com:p106352026-05-27T12:37:41Z
dc.title.none.fl_str_mv Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimester
title Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimester
spellingShingle Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimester
Miranda J
estimated fetal weight
fetal biometry
fetal growth restriction
screening
small-for-gestational age
third-trimester screening
title_short Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimester
title_full Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimester
title_fullStr Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimester
title_full_unstemmed Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimester
title_sort Prediction of fetal growth restriction using estimated fetal weight <i>vs</i> a combined screening model in the third trimester
dc.creator.none.fl_str_mv Miranda J
Rodriguez-Lopez M
Triunfo S
Sairanen M
Kouru H
Parra-Saavedra M
Crovetto F
Figueras F
Crispi F
Gratacos E
author Miranda J
author_facet Miranda J
Rodriguez-Lopez M
Triunfo S
Sairanen M
Kouru H
Parra-Saavedra M
Crovetto F
Figueras F
Crispi F
Gratacos E
author_role author
author2 Rodriguez-Lopez M
Triunfo S
Sairanen M
Kouru H
Parra-Saavedra M
Crovetto F
Figueras F
Crispi F
Gratacos E
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv estimated fetal weight
fetal biometry
fetal growth restriction
screening
small-for-gestational age
third-trimester screening
topic estimated fetal weight
fetal biometry
fetal growth restriction
screening
small-for-gestational age
third-trimester screening
description Objectives To compare the performance of third-trimester screening, based on estimated fetal weight centile (EFWc) vs a combined model including maternal baseline characteristics, fetoplacental ultrasound and maternal biochemical markers, for the prediction of small-for-gestational-age (SGA) neonates and late-onset fetal growth restriction (FGR). Methods This was a nested case-control study within a prospective cohort of 1590 singleton gestations undergoing third-trimester (32+0 to 36+6 weeks' gestation) evaluation. Maternal baseline characteristics, mean arterial pressure, fetoplacental ultrasound and circulating biochemical markers (placental growth factor (PlGF), lipocalin-2, unconjugated estriol and inhibin A) were assessed in all women who subsequently delivered a SGA neonate (n=175), defined as birth weight < 10th centile according to customized standards, and in a control group (n=875). Among SGA cases, those with birth weight < 3rd centile and/or abnormal uterine artery pulsatility index (UtA-PI) and/or abnormal cerebroplacental ratio (CPR) were classified as FGR. Logistic regression predictive models were developed for SGA and FGR, and their performance was compared with that obtained using EFWc alone. Results In SGA cases, EFWc, CPR Z-score and maternal serum concentrations of unconjugated estriol and PlGF were significantly lower, while mean UtA-PI Z-score and lipocalin-2 and inhibin A concentrations were significantly higher, compared with controls. Using EFWc alone, 52% (area under receiver-operating characteristics curve (AUC), 0.82 (95% CI, 0.77-0.85)) of SGA and 64% (AUC, 0.86 (95% CI, 0.81-0.91)) of FGR cases were predicted at a 10% false-positive rate. A combined screening model including a-priori risk (maternal characteristics), EFWc, UtA-PI, PlGF and estriol (with lipocalin-2 for SGA) achieved a detection rate of 61% (AUC, 0.86 (95% CI, 0.83-0.89)) for SGA cases and 77% (AUC, 0.92 (95% CI, 0.88-0.95)) for FGR. The combined model for the prediction of SGA and FGR performed significantly better than did using EFWc alone (P < 0.001 and P=0.002, respectively). Conclusions A multivariable integrative model of maternal characteristics, fetoplacental ultrasound and maternal biochemical markers modestly improved the detection of SGA and FGR cases at 32-36 weeks' gestation when compared with screening based on EFWc alone. Copyright (C) 2016 ISUOG. Published by John Wiley & Sons Ltd.
publishDate 2017
dc.date.none.fl_str_mv 2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=10635
url https://fsjd.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=10635
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv WILEY
publisher.none.fl_str_mv WILEY
dc.source.none.fl_str_mv ULTRASOUND IN OBSTETRICS & GYNECOLOGY
ISSN: 09607692
ISSNe: 14690705
reponame:r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
instname:Fundació Sant Joan de Déu
instname_str Fundació Sant Joan de Déu
reponame_str r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
collection r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu
repository.name.fl_str_mv
repository.mail.fl_str_mv
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