Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Ultrasound Obstet Gynecol. 2015 Aug;46(2):208-15. doi: 10.1002/uog.14861.
To investigate the potential value of serum placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (β-hCG) and α-fetoprotein (AFP) at 30-34 weeks' gestation in the prediction of delivery of small-for-gestational-age (SGA) neonates, in the absence of pre-eclampsia (PE).
This was a screening study in singleton pregnancies at 30-34 weeks' gestation, including 490 that delivered SGA neonates and 9360 cases that were unaffected by SGA, PE or gestational hypertension (normal outcome). Multivariable logistic regression analysis was used to determine if screening by serum PlGF, sFlt-1, PAPP-A, free β-hCG and AFP, individually or in combination, improved the prediction of SGA neonates provided by screening with maternal characteristics and medical history (maternal factors), and estimated fetal weight (EFW) from fetal head circumference, abdominal circumference and femur length.
Compared to the normal group, the mean log10 multiples of the median (MoM) values of PlGF and AFP were significantly lower and the mean log10 MoM values of sFlt-1 and free β-hCG were significantly higher in the SGA group with a birth weight < 5(th) percentile (SGA < 5(th)) delivering < 5 weeks following assessment. The best model for prediction of SGA was provided by a combination of maternal factors, EFW and serum PlGF. Such combined screening, predicted, at a 10% false-positive rate, 85%, 93% and 92% of SGA neonates delivering < 5 weeks following assessment with birth weight < 10(th), < 5(th) and < 3(rd) percentiles, respectively; the respective detection rates of combined screening for SGA neonates delivering ≥ 5 weeks following assessment were 57%, 64% and 71%.
Combined screening by maternal factors, EFW and serum PlGF at 30-34 weeks' gestation can identify a high proportion of pregnancies that subsequently deliver SGA neonates.
研究 30-34 孕周孕妇血清胎盘生长因子（PlGF）、可溶性 fms 样酪氨酸激酶-1（sFlt-1）、妊娠相关血浆蛋白-A（PAPP-A）、游离β-人绒毛膜促性腺激素（β-hCG）和甲胎蛋白（AFP）在预测无子痫前期（PE）情况下小于胎龄儿（SGA）新生儿中的潜在价值。
这是一项 30-34 孕周单胎妊娠的筛查研究，包括 490 例 SGA 新生儿分娩和 9360 例未受 SGA、PE 或妊娠期高血压影响的病例（正常结局）。采用多变量逻辑回归分析确定，通过血清 PlGF、sFlt-1、PAPP-A、游离β-hCG 和 AFP 单独或联合筛查，是否能改善基于母体特征和病史（母体因素）及胎儿头围、腹围和股骨长估计胎儿体重（EFW）的 SGA 新生儿筛查预测能力。
与正常组相比，出生体重<第 5 百分位（SGA<第 5 百分位）的 SGA 组中，PlGF 和 AFP 的中位数倍数（MoM）的平均值 log10 明显降低，sFlt-1 和游离β-hCG 的平均值 log10 MoM 明显升高，且在评估后<5 周分娩。预测 SGA 的最佳模型由母体因素、EFW 和血清 PlGF 联合提供。这种联合筛查，在假阳性率为 10%时，分别预测 85%、93%和 92%在评估后<5 周分娩、出生体重<第 10 百分位、第 5 百分位和第 3 百分位的 SGA 新生儿；在评估后≥5 周分娩的 SGA 新生儿中，联合筛查的检出率分别为 57%、64%和 71%。
在 30-34 孕周，通过母体因素、EFW 和血清 PlGF 联合筛查，可以识别出很大一部分随后分娩 SGA 新生儿的妊娠。
