Poon Leona C Y, Zaragoza Edgar, Akolekar Ranjit, Anagnostopoulos Evangelos, Nicolaides Kypros H
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Prenat Diagn. 2008 Dec;28(12):1110-5. doi: 10.1002/pd.2143.
To investigate the pathogenesis of pregnancies delivering small for gestational age (SGA) neonates by examining biochemical and Doppler indices of placental development during the first trimester of pregnancy.
The concentration of placental growth factor (PlGF) at 11(+0)-13(+6) weeks was measured in 296 cases, which delivered SGA neonates, and 609 controls. The newborn was considered to be SGA if the birth weight was less than the fifth percentile after correction for gestation at delivery and sex, maternal racial origin, weight, height and parity. The distributions of uterine artery pulsatility index (PI), PlGF and PAPP-A, expressed in multiples of the median (MoM), in the control and SGA groups were compared. Logistic regression analysis was used to determine if significant contribution is provided by maternal factors, PlGF, PAPP-A and uterine artery PI in predicting SGA.
The median PlGF (0.900 MoM) and PAPP-A (0.778 MoM) were lower and uterine artery PI was higher (1.087 MoM) in the SGA group than in the controls (PlGF: 0.991 MoM; PAPP-A: 1.070 MoM; uterine artery PI: 1.030 MoM). In the SGA group there was a significant association between PlGF and PAPP-A (r = 0.368, p < 0.0001) and uterine artery PI (r = 0.191, p = 0.001). Significant contributions for the prediction of SGA were provided by maternal factors, PlGF and PAPP-A and with combined screening the detection rate was 27% at a false-positive rate of 5%.
Birth weight is predetermined by placental development during the first trimester of pregnancy.
通过检测妊娠早期胎盘发育的生化指标和多普勒指标，探讨分娩小于胎龄（SGA）新生儿的妊娠发病机制。
测量296例分娩SGA新生儿的孕妇及609例对照孕妇在孕11（+0）至13（+6）周时胎盘生长因子（PlGF）的浓度。若新生儿出生体重经分娩时孕周、性别、母亲种族、体重、身高及产次校正后低于第五百分位数，则视为SGA。比较对照组和SGA组子宫动脉搏动指数（PI）、以中位数倍数（MoM）表示的PlGF和妊娠相关血浆蛋白-A（PAPP-A）的分布情况。采用逻辑回归分析确定母亲因素、PlGF、PAPP-A和子宫动脉PI在预测SGA方面是否有显著作用。
SGA组的PlGF中位数（0.900 MoM）和PAPP-A中位数（0.778 MoM）低于对照组（PlGF：0.991 MoM；PAPP-A：1.070 MoM），子宫动脉PI高于对照组（1.087 MoM）（子宫动脉PI：1.030 MoM）。在SGA组中，PlGF与PAPP-A之间存在显著相关性（r = 0.368，p < 0.0001），与子宫动脉PI也存在显著相关性（r = 0.191，p = 0.001）。母亲因素、PlGF和PAPP-A对SGA的预测有显著作用，联合筛查时在假阳性率为5%的情况下检测率为27%。
出生体重在妊娠早期由胎盘发育预先决定。
