Mendoza Manel, Hurtado Ivan, Bonacina Erika, Garcia-Manau Pablo, Serrano Berta, Tur Helena, Rodo Carlota, Maiz Nerea, Carreras Elena
Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Acta Obstet Gynecol Scand. 2021 Mar;100(3):504-512. doi: 10.1111/aogs.14032. Epub 2020 Nov 6.
Early-onset fetal growth restriction and small-for-gestational age of fetuses lead to an increased risk of adverse pregnancy outcomes. Doppler abnormalities can predict the occurrence of complications in the short term, but normal fetal Doppler values at the time of diagnosis do not exclude their occurrence in the long term. The objective of this study was to investigate the capacity of a predictive model to assess individual risks for prenatal counseling at the time of diagnosis.
This was a prospective observational study of singleton pregnancies with estimated fetal weight below the 10th centile between 20 and 31 weeks of gestational age. Placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) levels, estimated fetal weight centile, uterine artery pulsatility index, fetal Doppler and maternal risk factors for placental disease were assessed at the time of enrollment. The occurrence of adverse perinatal outcomes or the need for elective delivery at <30, <34 or <37 weeks was considered an adverse pregnancy outcomes. Univariable logistic regression analysis was used to examine the association between each predictive variable and the adverse outcomes. A multivariable logistic regression-based model was constructed with the combination of all variables. An additional model without sFlt-1/PlGF was also created. Both models, and the sFlt-1/PlGF alone, were used to develop the different formulas to assess individual risks. Receiver operating characteristic curves were constructed to assess and compare their performance of screening.
Forty-nine small-for-gestational-age fetuses and 124 with fetal growth restriction were enrolled at a median gestational age of 23.6 weeks. Elective delivery was needed in 77 (44.5%) women at <37 weeks, 53 (30.6%) women at <34 weeks and 30 (17.3%) at <30 weeks. Adverse perinatal outcomes occurred in 81 (55.9%) pregnancies. When areas under the curve were compared among models, no statistically significant differences were observed between the model with sFlt-1/PlGF and sFlt-1/PlGF alone; however, the model without sFlt-1/PlGF yielded an overall poorer performance.
Individual risk assessment can be made at the time of early-onset fetal growth restriction/small-for-gestational-age diagnosis, which permits accurate counseling of parents with an affected fetus. Two formulas could be used: one combining maternal characteristics and ultrasound findings and the other with a single sFlt-1/PlGF measurement.
早发型胎儿生长受限和小于胎龄儿会增加不良妊娠结局的风险。多普勒异常可在短期内预测并发症的发生，但诊断时胎儿多普勒值正常并不能排除长期并发症的发生。本研究的目的是探讨一种预测模型在诊断时评估个体产前咨询风险的能力。
这是一项对单胎妊娠进行的前瞻性观察研究，这些单胎妊娠的估计胎儿体重在孕20至31周时低于第10百分位数。在入组时评估胎盘生长因子（PlGF）和可溶性fms样酪氨酸激酶-1（sFlt-1）水平、估计胎儿体重百分位数、子宫动脉搏动指数、胎儿多普勒以及胎盘疾病的母体风险因素。小于30周、小于34周或小于37周时出现不良围产期结局或需要择期分娩被视为不良妊娠结局。采用单变量逻辑回归分析来检验每个预测变量与不良结局之间的关联。构建了一个基于多变量逻辑回归的模型，该模型结合了所有变量。还创建了一个不含sFlt-1/PlGF的额外模型。这两个模型以及单独的sFlt-1/PlGF均用于制定评估个体风险的不同公式。构建受试者工作特征曲线以评估和比较它们的筛查性能。
共纳入49例小于胎龄儿和124例胎儿生长受限的胎儿，中位孕周为23.6周。77例（44.5%）孕妇在小于37周时需要择期分娩，53例（30.6%）孕妇在小于34周时需要择期分娩，30例（17.3%）孕妇在小于30周时需要择期分娩。81例（55.9%）妊娠出现了不良围产期结局。在比较各模型的曲线下面积时，含sFlt-1/PlGF的模型与单独的sFlt-1/PlGF之间未观察到统计学上的显著差异；然而，不含sFlt-1/PlGF的模型总体表现较差。
在早发型胎儿生长受限/小于胎龄儿诊断时可进行个体风险评估，这有助于为患有受累胎儿的父母提供准确的咨询。可使用两个公式：一个结合母体特征和超声检查结果，另一个结合单次sFlt-1/PlGF测量值。
