Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
Ultrasound Obstet Gynecol. 2011 Mar;37(3):341-7. doi: 10.1002/uog.8808.
To examine early fetal growth, pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG) in relation to the risk of delivering a small-for-gestational age (SGA) infant.
Included in the study were 9450 singleton pregnant women who attended the prenatal screening program at Aarhus University Hospital, Denmark, between January 2005 and December 2007. Maternal serum levels of PAPP-A and free β-hCG were measured between gestational weeks 8 and 13. Two ultrasound examinations were performed, the first at 11-13 weeks and the second at 18-22 weeks, from which gestational age was estimated based on crown-rump length and biparietal diameter, respectively. Early fetal growth was expressed as an index: the ratio between the estimated number of days from the first to the second scan and the actual calendar time elapsed in days. SGA was defined as birth weight < 5(th) centile for gestational age, and the risk of SGA was evaluated according to different cut-offs of the early fetal growth index and the serum markers.
PAPP-A < 0.4 MoM combined with an early fetal growth index < 10(th) centile resulted in an increased risk of SGA (odds ratio (OR), 5.8; 95% CI, 2.7-12.7). Low PAPP-A, low free β-hCG and slow early fetal growth were statistically, independently associated with SGA, and the association between free β-hCG < 0.3 MoM and SGA was as strong as that between PAPP-A < 0.3 MoM and SGA (OR, 3.1 and 3.0, respectively).
The combination of slow early fetal growth and low PAPP-A resulted in a nearly six-fold increased risk of delivery of an SGA infant. These findings might improve our chances of early identification of fetuses at increased risk of growth restriction.
探讨早孕期胎儿生长、妊娠相关血浆蛋白-A（PAPP-A）和游离β-人绒毛膜促性腺激素（β-hCG）与出生小于胎龄儿（SGA）风险的关系。
本研究纳入了 9450 名于 2005 年 1 月至 2007 年 12 月在丹麦奥胡斯大学医院参加产前筛查计划的单胎孕妇。在妊娠 8 至 13 周时测量了母体血清 PAPP-A 和游离β-hCG 水平。进行了两次超声检查，第一次在 11-13 周，第二次在 18-22 周，分别根据头臀长和双顶间径估计妊娠龄。早孕期胎儿生长用指数表示：从第一次扫描到第二次扫描的估计天数与实际日历天数的比值。SGA 定义为出生体重<胎龄第 5 百分位数，根据早期胎儿生长指数和血清标志物的不同截断值评估 SGA 的风险。
PAPP-A<0.4 MoM 联合早期胎儿生长指数<第 10 百分位数与 SGA 风险增加相关（比值比（OR），5.8；95%置信区间，2.7-12.7）。低 PAPP-A、低游离β-hCG 和早期胎儿生长缓慢与 SGA 有统计学上的独立相关性，游离β-hCG<0.3 MoM 与 SGA 的相关性与 PAPP-A<0.3 MoM 与 SGA 的相关性一样强（OR 分别为 3.1 和 3.0）。
早期胎儿生长缓慢和 PAPP-A 水平低导致 SGA 婴儿的分娩风险增加近 6 倍。这些发现可能提高我们早期识别生长受限风险增加的胎儿的机会。
