Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, Denmark Hill, London, UK.
Fetal Diagn Ther. 2011;29(2):148-54. doi: 10.1159/000321694. Epub 2010 Nov 16.
To develop a model for prediction of small-for-gestational age (SGA) neonates in the absence of preeclampsia (PE) based on maternal factors and biophysical and biochemical markers at 11-13 weeks' gestation.
Screening study in 1,536 SGA and 31,314 non-SGA pregnancies based on maternal characteristics, fetal nuchal translucency (NT) thickness, serum pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotrophin (β-hCG). We also measured mean arterial pressure (MAP), uterine artery pulsatility index (PI) and performed case-control studies for measurement of maternal serum concentration of placental growth factor (PLGF), placental protein 13 (PP13) and A Disintegrin And Metalloprotease (ADAM12). Regression analysis was used to develop a model for the prediction of SGA.
In the SGA group, uterine artery PI and MAP were increased and serum PAPP-A, free β-hCG, PLGF, PP13, and ADAM12 and fetal NT were decreased. At a false positive rate of 10%, the estimated detection rate by a combination of maternal factors and biophysical and biochemical markers at 11-13 weeks was 73% for SGA requiring delivery before 37 weeks and 46% for those delivering at term.
Half of pregnancies with SGA neonates in the absence of PE could potentially be identified at 11-13 weeks.
在无先兆子痫（PE）的情况下，基于 11-13 周妊娠的母体因素及生物物理和生物化学标志物，建立预测胎儿生长受限（SGA）的模型。
在 1536 例 SGA 和 31314 例非 SGA 妊娠中进行筛查研究，纳入指标包括母体特征、胎儿颈项透明层（NT）厚度、血清妊娠相关血浆蛋白-A（PAPP-A）和游离β-人绒毛膜促性腺激素（β-hCG）。同时，我们还测量了平均动脉压（MAP）、子宫动脉搏动指数（PI），并进行了母体血清胎盘生长因子（PLGF）、胎盘蛋白 13（PP13）和 A 型溶酶体金属蛋白酶（ADAM12）的病例对照研究。采用回归分析建立预测 SGA 的模型。
在 SGA 组中，子宫动脉 PI 和 MAP 升高，血清 PAPP-A、游离β-hCG、PLGF、PP13 和 ADAM12 及胎儿 NT 降低。在假阳性率为 10%的情况下，11-13 周时联合应用母体因素和生物物理及生物化学标志物预测在 37 周前分娩的 SGA 的估计检出率为 73%，预测足月分娩的 SGA 的检出率为 46%。
在无 PE 的情况下，有一半的 SGA 新生儿可以在 11-13 周被识别。
