Parisi Francesca, Coco Chiara, Esposito Giovanna, Guerriero Stefano, Savasi Valeria, Marozio Luca, Petraglia Felice, Spinillo Arsenio, Guida Maurizio, Capobianco Giampiero, Di Simone Nicoletta, Morlando Maddalena, D'anna Rosario, Nappi Luigi, Cetin Irene
SC Ostetricia, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy.
Eur J Clin Nutr. 2025 Apr 30. doi: 10.1038/s41430-025-01619-9.
To evaluate associations between the first trimester SIMPLE nutritional score, early placental markers, and pregnancy outcome.
This is a longitudinal prospective multicenter observational cohort study recruiting healthy women with no comorbidities and singleton viable pregnancies undergoing first trimester prenatal screening. The SIMPLE nutritional score, biochemical (pregnancy-associated plasma protein A (PAPP-a), free ß-human chorionic gonadotropin (β-HCG)) and ultrasound (placental volume, uterine artery Doppler velocimetry) markers of placental function were collected at enrollment. Birth outcomes were collected at delivery.
Multivariate generalized linear and logistic regression models were performed to investigate associations between SIMPLE score subgroups (<6 versus ≥6) and items, placental markers, and pregnancy outcomes.
Out of 2363 women enrolled, 325 were classified at high nutritional risk based on a first trimester SIMPLE score lower than 6. Multi-adjusted models showed that the SIMPLE score subgroup was significantly associated with first trimester PAPP-a concentrations (SIMPLE score ≥6 versus <6: β = 0.047 (95% CI 0.004;0.089), p < 0.05), as well as with the emergency cesarean section rates (SIMPLE score ≥6 versus <6: aOR = 0.73 (95% CI -1.38;-0.07), p < 0.05). The single item related to the first trimester hemoglobin concentrations higher than 110 g/L was significantly associated with early placental markers, birth (β = -116.2 (95% CI -213.6;18.7), p < 0.05) and placental weights (β = -28.2 (95% CI -50.4;6.0), p < 0.05) in multi-adjusted models.
The observed associations support the introduction of the SIMPLE score in clinical practice as a useful tool for predicting early placental development and pregnancy outcome.
评估孕早期SIMPLE营养评分、早期胎盘标志物与妊娠结局之间的关联。
这是一项纵向前瞻性多中心观察性队列研究，招募无合并症且单胎活产妊娠的健康女性进行孕早期产前筛查。在入组时收集SIMPLE营养评分、胎盘功能的生化指标（妊娠相关血浆蛋白A（PAPP-a）、游离β-人绒毛膜促性腺激素（β-HCG））和超声指标（胎盘体积、子宫动脉多普勒测速）。在分娩时收集出生结局。
采用多变量广义线性和逻辑回归模型，研究SIMPLE评分亚组（<6 vs ≥6）与各项指标、胎盘标志物及妊娠结局之间的关联。
在2363名入组女性中，325名因孕早期SIMPLE评分低于6而被归类为高营养风险。多因素调整模型显示，SIMPLE评分亚组与孕早期PAPP-a浓度显著相关（SIMPLE评分≥6 vs <6：β = 0.047（95%CI 0.004；0.089），p < 0.05），以及与急诊剖宫产率显著相关（SIMPLE评分≥6 vs <6：aOR = 0.73（95%CI -1.38；-0.07），p < 0.05）。在多因素调整模型中，与孕早期血红蛋白浓度高于110 g/L相关的单项指标与早期胎盘标志物、出生（β = -116.2（95%CI -213.6；18.7），p < 0.05）和胎盘重量（β = -28.2（95%CI -50.4；6.0），p < 0.05）显著相关。
观察到的关联支持在临床实践中引入SIMPLE评分作为预测早期胎盘发育和妊娠结局的有用工具。
