Maternal-Fetal Medicine Department, ICGON, Hospital Clínic, Universitat de Barcelona; Fetal and Perinatal Medicine Research Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain; Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Dipartimento Ostetricia e Ginecologia, Univerisità degli Studi di Milano, Milan, Italy.
Ultrasound Obstet Gynecol. 2014 Jan;43(1):34-40. doi: 10.1002/uog.12537. Epub 2013 Dec 8.
To assess the effectiveness of first-trimester screening for early and late small-for-gestational-age (SGA) neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler.
This was a prospective study of 4970 women with a singleton pregnancy who underwent routine first-trimester screening between 2009 and 2011. A logistic regression-based predictive model for SGA, defined as birth weight < 10(th) percentile, divided into early- or late-onset based on gestational age at delivery before or after 34 weeks' gestation, was constructed. The model included maternal baseline characteristics: serum levels of pregnancy-associated plasma protein-A and free β-human chorionic gonadotropin at 8-12 weeks and blood pressure and uterine artery Doppler at 11 + 0 to 13 + 6 weeks.
The prevalence of early and late SGA was 0.6% and 7.9%, respectively. Association with pre-eclampsia was 67% and 8%, respectively. At a false-positive rate of 15%, the detection rate for early SGA was 73%; however it differed substantially for cases with and without pre-eclampsia (90% vs 40%). For late SGA, at false-positive rates of 15 and 50%, detection rates were 32% and 70%, respectively, and did not substantially differ between cases with and without pre-eclampsia.
First-trimester screening predicts early SGA mainly because of its strong association with pre-eclampsia. Although prediction of late SGA was poorer, at a high false-positive rate it might be considered as part of a first-trimester strategy to select women requiring ultrasound assessment in the third trimester.
评估使用母体血清生化、血压和子宫动脉多普勒在早、晚期胎儿生长受限（SGA）新生儿中的早期筛查效果。
这是一项前瞻性研究，共纳入 4970 名单胎妊娠女性，于 2009 年至 2011 年期间进行常规早孕期筛查。基于逻辑回归建立了一种预测 SGA 的模型，SGA 定义为出生体重<第 10 百分位数，根据分娩时的胎龄分为早发性或晚发性，在 34 周前或后。模型包括母体的基线特征：妊娠相关血浆蛋白 A 和游离β-人绒毛膜促性腺激素在 8-12 周时的血清水平，以及在 11+0 至 13+6 周时的血压和子宫动脉多普勒。
早发性和晚发性 SGA 的患病率分别为 0.6%和 7.9%。与子痫前期的相关性分别为 67%和 8%。在假阳性率为 15%的情况下，早发性 SGA 的检出率为 73%；然而，它在有和没有子痫前期的病例中差异很大（90%与 40%）。对于晚发性 SGA，在假阳性率为 15%和 50%的情况下，检出率分别为 32%和 70%，并且在有和没有子痫前期的病例中差异不大。
早孕期筛查主要预测早发性 SGA，因为它与子痫前期密切相关。虽然对晚发性 SGA 的预测较差，但在高假阳性率下，它可能被视为早期妊娠策略的一部分，以选择需要在孕晚期进行超声评估的女性。
