Queirós Alexandra, Bernardo Ana, Rijo Cláudia, Carocha Ana, Ferreira Leonor, Martins Ana Teresa, Cohen Álvaro, Alves Marta, Papoila Ana Luísa, Simões Teresinha
Fetal Medicine and Surgery Center, São José Local Health Unit, Centro Clínico Académico de Lisboa, Lisbon, Portugal.
Maternal and Fetal Medicine Unit, São José Local Health Unit, Centro Clínico Académico de Lisboa, Lisbon, Portugal.
Arch Gynecol Obstet. 2025 Jan;311(1):43-53. doi: 10.1007/s00404-024-07884-6. Epub 2024 Dec 26.
This study aimed to investigate the association between maternal factors and first-trimester biophysical and biochemical markers with small for gestational age (SGA) neonates in twin pregnancies (TwPs).
Single-center retrospective cohort study of TwPs followed from January 2010 to December 2022 at a tertiary perinatal center, Portugal. Maternal and pregnancy characteristics, mean arterial pressure, pregnancy-associated plasma protein-A (PAPP-A), β-human chorionic gonadotropin (β-HCG), and uterine artery pulsatility index (UtA-PI) were analyzed. Univariable, multivariable logistic regression (LR) and receiver-operating characteristic curve analyses were performed. The main outcome measures considered were: SGA < 3rd, < 5th and < 10th percentile, the composite outcome of SGA combined with preterm birth (PTB) (< 32, < 34, and < 36 weeks).
572 TwPs were included, 450 (78.7%) DC and 122 (21.3%) MC. TwPs affected with SGA < 3rd, < 5th or < 10th percentiles were 120/572 (20.9%), 157/572 (27.4%) and 190/572 (33.2%), respectively. SGA < 3rd percentile was associated with a higher rate of PTB, 59.0% of cases < 32 weeks, OR 6.4 (95% CI: 3.2-12.7, p < 0.001). Shorter maternal height, UtA-PI ≥ 95th percentile, and low PAPP-A were identified as significant independent risk factors associated with SGA and SGA combined with PTB. The best LR model was obtained for the composite outcome SGA < 3rd percentile and PTB < 32 weeks, with an AUC of 0.834, a sensitivity rate of 77%, and a false positive rate of 17%.
The majority of pregnancies at risk for SGA combined with prematurity can be detected in the first trimester. However, larger datasets are necessary to develop robust predictive models.
本研究旨在调查双胎妊娠（TwP）中母亲因素及孕早期生物物理和生化指标与小于胎龄（SGA）新生儿之间的关联。
对2010年1月至2022年12月在葡萄牙一家三级围产期中心进行随访的双胎妊娠进行单中心回顾性队列研究。分析了母亲和妊娠特征、平均动脉压、妊娠相关血浆蛋白A（PAPP - A）、β - 人绒毛膜促性腺激素（β - HCG）和子宫动脉搏动指数（UtA - PI）。进行了单变量、多变量逻辑回归（LR）和受试者工作特征曲线分析。主要结局指标包括：SGA＜第3百分位数、＜第5百分位数和＜第10百分位数，SGA合并早产（PTB）（＜32周、＜34周和＜36周）的复合结局。
纳入572例双胎妊娠，其中450例（78.7%）为双绒毛膜双胎（DC），122例（21.3%）为单绒毛膜双胎（MC）。SGA＜第3百分位数、＜第5百分位数或＜第10百分位数的双胎妊娠分别为120/572（20.9%）、157/572（27.4%）和190/572（33.2%）。SGA＜第3百分位数与较高的PTB发生率相关，59.0%的病例＜32周，比值比（OR）为6.4（95%置信区间：3.2 - 12.7，p＜0.001）。母亲身高较短、UtA - PI≥第95百分位数和低PAPP - A被确定为与SGA以及SGA合并PTB相关的显著独立危险因素。对于SGA＜第3百分位数和PTB＜32周的复合结局，获得了最佳的LR模型，曲线下面积（AUC）为0.834，灵敏度为77%，假阳性率为17%。
大多数有SGA合并早产风险的妊娠可在孕早期检测到。然而，需要更大的数据集来开发强大的预测模型。
