早孕期及早中孕期联合预测小于胎龄儿及早中孕期晚期胎儿生长受限

First-trimester and combined first- and second-trimester prediction of small-for-gestational age and late fetal growth restriction.

机构信息

Second Department of Obstetrics and Gynecology, Aristotle University Medical School, Thessaloniki, Greece.

BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.

出版信息

Ultrasound Obstet Gynecol. 2019 Jan;53(1):55-61. doi: 10.1002/uog.19055. Epub 2018 Nov 26.

DOI:10.1002/uog.19055

PMID:29573501

Abstract

OBJECTIVE

To develop a first-trimester or combined first- and second-trimester screening algorithm for the prediction of small-for-gestational age (SGA) and late fetal growth restriction (FGR).

METHODS

This was a retrospective study of women with singleton pregnancy, who underwent routine first-, second- and third-trimester ultrasound assessment. Late FGR was defined, at ≥ 32 weeks' gestation in the absence of congenital anomalies, as either (i) estimated fetal weight (EFW) or birth weight (BW) < 3 centile, or (ii) EFW < 10 centile and either uterine artery mean pulsatility index (UtA-PI) > 95 centile or cerebroplacental ratio (CPR) < 5 centile. Neonates with BW < 10 centile, regardless of prenatal parameters, were defined as SGA. The predictive effectiveness of maternal and first- and second-trimester factors was tested using logistic regression and receiver-operating characteristics curve analyses.

RESULTS

A total of 3520 fetuses were included (late FGR, n = 109 (3.1%); SGA, n = 292 (8.3%)). Of the late FGR cases, 56 (1.6%) fulfilled the antenatal criteria (EFW < 3 centile or EFW < 10 centile plus abnormal UtA-PI or CPR) and were defined as prenatally detected late FGR. A first-trimester screening model (comprising conception method, smoking status, maternal height, pregnancy-associated plasma protein-A (PAPP-A) and UtA-PI) could predict 50.0% of the prenatally diagnosed and 36.7% of the overall late FGR fetuses for a 10% false-positive rate (FPR). A model combining first- and second-trimester screening parameters (conception method, smoking status, PAPP-A, second- trimester EFW, head circumference/abdominal circumference ratio and UtA-PI) could predict 78.6% of the prenatally detected, and 59.6% of the overall late FGR fetuses, for a 10% FPR (area under the curve 0.901 (95% CI, 0.856-0.947) and 0.855 (95% CI, 0.818-0.891), respectively). The prediction of SGA was suboptimal for both first-trimester and combined screening.

CONCLUSIONS

A simple model combining maternal and first- and second-trimester predictors can detect 60% of fetuses that will develop late FGR, and 79% of those fetuses that will be classified prenatally as late FGR, for a 10% FPR. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

摘要

目的

开发一种用于预测胎儿生长受限（FGR）和晚期胎儿生长受限（FGR）的孕早期或早中孕期联合筛查算法。

方法

这是一项回顾性研究，纳入了接受常规早、中、晚期超声评估的单胎妊娠妇女。晚期 FGR 定义为无先天畸形的孕妇在≥32 周妊娠时出现以下两种情况之一：（i）估计胎儿体重（EFW）或出生体重（BW）<第 3 百分位数，或（ii）EFW<第 10 百分位数，且子宫动脉平均搏动指数（UtA-PI）>第 95 百分位数或胎盘-胎儿比值（CPR）<第 5 百分位数。BW<第 10 百分位数的新生儿，无论产前参数如何，均定义为 SGA。使用逻辑回归和受试者工作特征曲线分析来测试母体和早、中孕期因素的预测效果。

结果

共纳入 3520 例胎儿（晚期 FGR，n=109（3.1%）；SGA，n=292（8.3%））。晚期 FGR 病例中，56 例（1.6%）符合产前标准（EFW<第 3 百分位数或 EFW<第 10 百分位数加异常 UtA-PI 或 CPR），并被定义为产前诊断的晚期 FGR。早孕期筛查模型（包括受孕方式、吸烟状况、孕妇身高、妊娠相关血浆蛋白-A（PAPP-A）和 UtA-PI）可预测 50.0%的产前诊断和 36.7%的总体晚期 FGR 胎儿，假阳性率（FPR）为 10%。中孕期筛查参数（受孕方式、吸烟状况、PAPP-A、中孕期 EFW、头围/腹围比和 UtA-PI）联合模型可预测 78.6%的产前诊断和 59.6%的总体晚期 FGR 胎儿，FPR 为 10%（曲线下面积为 0.901（95%CI，0.856-0.947）和 0.855（95%CI，0.818-0.891））。早孕期和联合筛查对 SGA 的预测效果均不佳。