Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 32 and 36 weeks

Journal article


Ciobanu, A., Anthoulakis, C., Syngelaki, A., Akolekar, R. and Nicolaides, K.H. 2019. Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 32 and 36 weeks. Ultrasound in Obstetrics and Gynecology. 53 (5), pp. 630-637. https://doi.org/10.1002/uog.20267
AuthorsCiobanu, A., Anthoulakis, C., Syngelaki, A., Akolekar, R. and Nicolaides, K.H.
Abstract

Objective: To assess the additive value of fetal growth velocity between 32 and 36 weeks’ gestation on the performance of ultrasonographic estimated fetal weight (EFW) at 35+0 - 36+6 weeks’ gestation for prediction of small for gestational age (SGA) neonates and adverse perinatal outcome.

Methods: This was a prospective study of 14,497 singleton pregnancies that had undergone routine ultrasound examination at 28+0 - 34+6 and at 35+0 - 36+6 weeks’ gestation. Multivariable logistic regression analysis was used to determine whether addition of growth velocity, defined by a difference in EFW and abdominal circumference (AC) Z-scores between the early and late third trimester scans divided by the time interval between them, improved the performance of EFW at 35+0 - 36+6 weeks in the prediction of first, delivery of SGA neonates with birthweight <10th and <3rd percentiles within two weeks and at any stage after assessment and second, composite of adverse perinatal outcome defined as stillbirth, neonatal death or admission to the neonatal unit for ≥48 hours.

Results Multivariable logistic regression analysis demonstrated that significant contributors to prediction of SGA neonates were EFW Z-score at 35+0 - 36+6 weeks’ gestation, fetal growth velocity by either AC or EFW Z-scores and maternal risk factors. The area under the receiver operating characteristic curves (AUROC) and detection rate (DR) with 95% confidence interval, at 10% screen positive rate, for prediction of SGA neonates <10th percentile born within two weeks of assessment achieved by EFW Z-score at 35+0 - 36+6 weeks (AUROC 0.938, 0.928 - 0.947; DR 80.7, 77.6 - 83.9) were not significantly improved by addition of EFW growth velocity and maternal risk factors (AUROC 0.941, 0.932 - 0.950; p=0.061; DR 82.5, 79.4 - 85.3). Similar results were obtained when growth velocity was defined by AC rather than EFW growth velocity. Similarly, there was no significant improvement in AUROC and DR, at 10% screen positive rate, for prediction of SGA neonates <10th percentile born at any stage after assessment or SGA neonates <3rd percentile born within two weeks or at any stage after assessment achieved by EFW Z-score at 35+0 - 36+6 weeks by addition of maternal factors and either EFW growth velocity of AC growth velocity. Multivariable logistic regression analysis demonstrated that the only significant contributor to adverse perinatal outcome was maternal risk factors. Multivariable logistic regression analysis in the group with EFW <10th percentile demonstrated that significant contribution to prediction of birth of neonates with birthweight <10th and <3rd percentiles and adverse perinatal outcome was provided by EFW Z-score at 35+0 - 36+6 weeks, but not by AC growth velocity <1st decile.

Conclusion: The predictive performance of EFW at 35+0 - 36+6 weeks’ gestation for birth of SGA neonates and adverse perinatal outcome is not improved by addition of estimated growth velocity between 32 and 36 weeks’ gestation.

KeywordsThird trimester screening; Small for gestational age; Growth velocity; Estimated fetal weight; Growth charts.
Year2019
JournalUltrasound in Obstetrics and Gynecology
Journal citation53 (5), pp. 630-637
PublisherWiley
ISSN1469-0705
Digital Object Identifier (DOI)https://doi.org/10.1002/uog.20267
Official URLhttp://doi.org/10.1002/uog.20267
Related URLhttps://pubmed.ncbi.nlm.nih.gov/30912210/
Publication dates
Online26 Mar 2019
Publication process dates
Accepted14 Mar 2019
Deposited15 Jun 2020
Accepted author manuscript
Output statusPublished
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Prevention of stillbirths: impact of a two-stage screening for vasa previa
Zhang, W., Geris, S., Beta, J., Ramadan, G., Nicolaides, K. H. and Akolekar, R. 2019. Prevention of stillbirths: impact of a two-stage screening for vasa previa. Ultrasound in Obstetrics and Gynecology. 55 (5), pp. 605-612. https://doi.org/10.1002/uog.21953
Impact of prospective measurement of outflow tracts in the prediction of coarctation of the aorta
Vigneswaran, T. V., Zidere, V., Chivers, S., Charakida, M., Akolekar, R. and Simpson, J. M. 2019. Impact of prospective measurement of outflow tracts in the prediction of coarctation of the aorta. Ultrasound in Obstetrics and Gynecology. https://doi.org/10.1002/uog.21957
Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with high nuchal translucency, tricuspid regurgitation and abnormal flow in the ductus venosus
Minnella, G. P., Crupano, F. M., Syngelaki, A., Zidere, V., Akolekar, R. and Nicolaides, K. H. 2019. Diagnosis of major heart defects by routine first-trimester ultrasound examination: association with high nuchal translucency, tricuspid regurgitation and abnormal flow in the ductus venosus. Ultrasound in Obstetrics and Gynecology. 55 (5), pp. 637-644. https://doi.org/10.1002/uog.21956
Screening for pre-eclampsia using sFlt-1/PlGF ratio cut-off of 38 at 30-37 weeks' gestation
Dragan, I., Georgiou, T., Prodan, N., Akolekar, R. and Nicolaides, K. H. 2017. Screening for pre-eclampsia using sFlt-1/PlGF ratio cut-off of 38 at 30-37 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 49 (1), pp. 73-77. https://doi.org/10.1002/uog.17301
Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2016. Uterine artery pulsatility index at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (3), pp. 308-315. https://doi.org/10.1002/uog.14898
Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2016. Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (2), pp. 194-202. https://doi.org/10.1002/uog.14928
Screening for trisomies by cell-free DNA testing of maternal blood: consequences of a failed result
Revello, R., Sarno, L., Ispas, A., Akolekar, R. and Nicolaides, K. H. 2016. Screening for trisomies by cell-free DNA testing of maternal blood: consequences of a failed result. Ultrasound in Obstetrics and Gynecology. 47 (6), pp. 698-704. https://doi.org/10.1002/uog.15851
Metformin versus placebo in obese pregnant women without diabetes mellitus
Syngelaki, A., Nicolaides, K. H., Balani, J., Hyer, S., Akolekar, R., Kotecha, R., Pastides, A. and Shehata, H. 2016. Metformin versus placebo in obese pregnant women without diabetes mellitus. New England Journal of Medicine. 374, pp. 434-43. https://doi.org/10.1056/NEJMoa1509819
Prospective first-trimester screening for trisomies by cell-free DNA testing of maternal blood in twin pregnancy
Sarno, L., Revello, R., Hanson, E., Akolekar, R. and Nicolaides, K. H. 2016. Prospective first-trimester screening for trisomies by cell-free DNA testing of maternal blood in twin pregnancy. Ultrasound in Obstetrics and Gynecology. 47 (6), pp. 705-11. https://doi.org/10.1002/uog.15913
Prediction of stillbirth from biochemical and biophysical markers at 11-13 weeks
Mastrodima, S., Akolekar, R., Yerlikaya, G., Tzelepis, T. and Nicolaides, K. H. 2016. Prediction of stillbirth from biochemical and biophysical markers at 11-13 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 613-617. https://doi.org/10.1002/uog.17289
Prediction of stillbirth from maternal demographic and pregnancy characteristics
Yerlikaya, G., Akolekar, R., McPherson, K., Syngelaki, A. and Nicolaides, K. H. 2016. Prediction of stillbirth from maternal demographic and pregnancy characteristics. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 607-612. https://doi.org/10.1002/uog.17290
Endoscopic placental laser coagulation in dichorionic and monochorionic triplet pregnancies
Peeva, G., Chaveeva, P., Gil Guevara, E., Akolekar, R. and Nicolaides, K. H. 2016. Endoscopic placental laser coagulation in dichorionic and monochorionic triplet pregnancies. Fetal Diagnosis and Therapy. 40 (3), pp. 174-180. https://doi.org/10.1159/000443792
Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks
Akolekar, R., Tokunaka, M., Ortega, N., Syngelaki, A. and Nicolaides, K. H. 2016. Prediction of stillbirth from maternal factors, fetal biometry and uterine artery Doppler at 19-24 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 624-630. https://doi.org/10.1002/uog.17295
Prediction of stillbirth from placental growth factor at 11-13 weeks
Akolekar, R., Machuca, M., Mendes, M., Paschos, V. and Nicolaides, K. H. 2016. Prediction of stillbirth from placental growth factor at 11-13 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 618-623. https://doi.org/10.1002/uog.17288
Prediction of stillbirth from placental growth factor at 19-24 weeks
Aupont J. E., Akolekar, R., Illian, A., Neonakis, S. and Nicolaides, K. H. 2016. Prediction of stillbirth from placental growth factor at 19-24 weeks. Ultrasound in Obstetrics and Gynecology. 48 (5), pp. 631-635. https://doi.org/10.1002/uog.17229
Biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome
Valiño, N., Giunta, G., Gallo, D. M., Akolekar, R. and Nicolaides, K. H. 2015. Biophysical and biochemical markers at 35-37 weeks' gestation in the prediction of adverse perinatal outcome. Ultrasound in Obstetrics and Gynecology. 47 (2), pp. 203-209. https://doi.org/10.1002/uog.15663