Albaiges G, Papastefanou I, Rodriguez I, Prats P, Echevarria M, Rodriguez M A, Rodriguez Melcon A
Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain.
Fetal Medicine Research Institute, King's College Hospital, London, UK.
Ultrasound Obstet Gynecol. 2023 Aug;62(2):202-208. doi: 10.1002/uog.26210.
To examine the external validity of the new Fetal Medicine Foundation (FMF) competing-risks model for prediction in midgestation of small-for-gestational-age (SGA) neonates.
This was a single-center prospective cohort study of 25 484 women with a singleton pregnancy undergoing routine ultrasound examination at 19 + 0 to 23 + 6 weeks' gestation. The FMF competing-risks model for the prediction of SGA combining maternal factors and midgestation estimated fetal weight by ultrasound scan (EFW) and uterine artery pulsatility index (UtA-PI) was used to calculate risks for different cut-offs of birth-weight percentile and gestational age at delivery. The predictive performance was evaluated in terms of discrimination and calibration.
The validation cohort was significantly different in composition compared with the FMF cohort in which the model was developed. In the validation cohort, at a 10% false-positive rate (FPR), maternal factors, EFW and UtA-PI yielded detection rates of 69.6%, 38.7% and 31.7% for SGA < 10 percentile with delivery at < 32, < 37 and ≥ 37 weeks' gestation, respectively. The respective values for SGA < 3 percentile were 75.7%, 48.2% and 38.1%. Detection rates in the validation cohort were similar to those reported in the FMF study for SGA with delivery at < 32 weeks but lower for SGA with delivery at < 37 and ≥ 37 weeks. Predictive performance in the validation cohort was similar to that reported in a subgroup of the FMF cohort consisting of nulliparous and Caucasian women. Detection rates in the validation cohort at a 15% FPR were 77.4%, 50.0% and 41.5% for SGA < 10 percentile with delivery at < 32, < 37 and ≥ 37 weeks, respectively, which were similar to the respective values reported in the FMF study at a 10% FPR. The model had satisfactory calibration.
The new competing-risks model for midgestation prediction of SGA developed by the FMF performs well in a large independent Spanish population. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
检验胎儿医学基金会（FMF）新的竞争风险模型在预测小于胎龄（SGA）新生儿中期妊娠情况时的外部有效性。
这是一项单中心前瞻性队列研究，纳入了25484名单胎妊娠女性，她们在妊娠19+0至23+6周时接受常规超声检查。使用FMF竞争风险模型预测SGA，该模型结合了母体因素、超声扫描估计的胎儿体重（EFW）和子宫动脉搏动指数（UtA-PI），用于计算不同出生体重百分位数和分娩孕周临界值的风险。从区分度和校准度方面评估预测性能。
与开发该模型的FMF队列相比，验证队列在组成上有显著差异。在验证队列中，在10%假阳性率（FPR）时，对于孕周<32周、<37周和≥37周分娩的SGA<第10百分位数，母体因素、EFW和UtA-PI的检出率分别为69.6%、38.7%和31.7%。对于SGA<第3百分位数，相应的值分别为75.7%、48.2%和38.1%。验证队列中对于孕周<32周分娩的SGA的检出率与FMF研究报告的相似，但对于孕周<37周和≥37周分娩的SGA的检出率较低。验证队列中的预测性能与FMF队列中由未生育和白种女性组成的亚组报告的相似。在15%FPR时，验证队列中对于孕周<32周、<37周和≥37周分娩的SGA<第10百分位数的检出率分别为77.4%、50.0%和41.5%，与FMF研究在10%FPR时报告的相应值相似。该模型具有良好的校准度。
FMF开发的用于SGA中期妊娠预测的新竞争风险模型在一个大型独立的西班牙人群中表现良好。©2023国际妇产科超声学会。
