Zhao Ying, Xu Lei, An Ping, Zhou Jizi, Zhu Jie, Liu Shuangping, Zhou Qiongjie, Li Xiaotian, Xiong Yu
Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
Chang Ning Maternity & Infant Health Hospital, Shanghai, China.
BMC Pregnancy Childbirth. 2025 Feb 11;25(1):132. doi: 10.1186/s12884-025-07252-5.
Fetal growth restriction (FGR) is a major determinant of perinatal morbidity and mortality. Our study aimed to develop a prediction model for the risk of FGR developing adverse perinatal outcome (APO) and evaluate its performance.
This was a prospective observational cohort study of consecutive singleton gestations meeting the ACOG-endorsed criteria for FGR from January 2022 to June 2023 at Obstetrics and Gynecology Hospital of Fudan University. Clinical information, ultrasound indicators and serum biomarkers were collected. The primary composite APO comprised one or more of: perinatal death, intrauterine demise, intraventricular hemorrhage, periventricular leukomalacia, seizures, necrotizing enterocolitis, neonatal respiratory distress syndrome, sepsis and the length of stay in the neonatal intensive care unit > 7 days. Least absolute shrinkage and selection operator regression was used to screen variables for nomogram model construction. The discrimination, calibration and clinical effectiveness of the nomogram were evaluated using receiver operating characteristic curve, calibration plots and decision curve analysis in training and validation cohorts.
A total of 122 pregnancies were enrolled in the final statistical analysis. Five variables were identified to establish a nomogram, including gestational weeks at diagnosis, abnormal umbilical artery Doppler, abnormal uterine artery Doppler, and multiples of the median values of placental growth factor and soluble fms-like tyrosine kinase-1. The area under the receiver-operating-characteristics curve of 0.87 (95% CI, 0.75-0.99) and 0.86 (95% CI, 0.74-0.98) in the training and validation cohort respectively, indicated satisfactory discriminative ability of the nomogram. The calibration plots showed favorable consistency between the nomogram's predictions and actual observations. Decision curve analysis supported its practical value in a clinical setting.
A nomogram was developed and validated to possess the promising capacity of predicting APO in FGR-afflicted neonates, and may prove useful in counseling and management of pregnancies complicated by FGR.
胎儿生长受限（FGR）是围产期发病率和死亡率的主要决定因素。我们的研究旨在开发一种预测模型，以预测FGR发生不良围产期结局（APO）的风险，并评估其性能。
这是一项前瞻性观察队列研究，研究对象为2022年1月至2023年6月在复旦大学附属妇产科医院连续单胎妊娠且符合美国妇产科医师学会（ACOG）认可的FGR标准的孕妇。收集临床信息、超声指标和血清生物标志物。主要复合APO包括以下一项或多项：围产期死亡、宫内死亡、脑室内出血、脑室周围白质软化、癫痫发作、坏死性小肠结肠炎、新生儿呼吸窘迫综合征、败血症以及新生儿重症监护病房住院时间>7天。采用最小绝对收缩和选择算子回归筛选变量，用于构建列线图模型。在训练队列和验证队列中，使用受试者工作特征曲线、校准图和决策曲线分析评估列线图的辨别力、校准度和临床有效性。
共有122例妊娠纳入最终统计分析。确定了五个变量来建立列线图，包括诊断时的孕周、脐动脉多普勒异常、子宫动脉多普勒异常以及胎盘生长因子和可溶性fms样酪氨酸激酶-1中位数倍数。训练队列和验证队列中受试者工作特征曲线下面积分别为0.87（95%CI，0.75-0.99）和0.86（95%CI，0.74-0.98），表明列线图具有良好的辨别能力。校准图显示列线图预测与实际观察结果之间具有良好的一致性。决策曲线分析支持其在临床环境中的实用价值。
开发并验证了一种列线图，该列线图具有预测FGR新生儿APO的良好能力，可能对FGR合并妊娠的咨询和管理有用。
