Prediction of small for gestational age neonates: screening by maternal factors, fetal biometry, and biomarkers at 35-37 weeks' gestation

Journal article


Ciobanu, A., Rouvali, A., Syngelaki, A., Akolekar, R. and Nicolaides, K.H. 2019. Prediction of small for gestational age neonates: screening by maternal factors, fetal biometry, and biomarkers at 35-37 weeks' gestation. American Journal of Obstetrics & Gynecology. 220 (5), pp. 486.e1-486.e11.
AuthorsCiobanu, A., Rouvali, A., Syngelaki, A., Akolekar, R. and Nicolaides, K.H.
Abstract

Background: Small for gestational age (SGA) neonates are at increased risk of perinatal mortality and morbidity, but the risks can be substantially reduced if the condition is identified prenatally, because in such cases close monitoring and appropriate timing of delivery and prompt neonatal care can be undertaken. The traditional approach of identifying pregnancies with SGA fetuses is maternal abdominal palpation and serial measurements of symphysial-fundal height, but the detection rate of this approach is less than 30%. A higher performance of screening for SGA is achieved by sonographic fetal biometry during the third trimester; screening at 30-34 weeks’ gestation identifies about 80% of SGA neonates delivering preterm but only 50% of those delivering at term, at screen positive rate of 10%. There is some evidence that routine ultrasound examination at 36 weeks' gestation is more effective than that at 32 weeks in predicting birth of SGA neonates.

Objective: To investigate the potential value of maternal characteristics and medical history, sonographycally estimated fetal weight (EFW) and biomarkers of impaired placentation at 35+0 - 36+6 weeks’ gestation in the prediction of delivery of small for gestational age (SGA) neonates.

Methods: A dataset of 124,443 prospectively examined singleton pregnancies at 11+0 - 13+6 weeks’ gestation was used to derive, through multivariable logistic regression analysis, the patient-specific prior risk for delivery of SGA neonate with birthweight <10th percentile for gestational age from maternal characteristics and medical history. A dataset of 19,209 singleton pregnancies undergoing screening at 35+0 - 36+6 weeks’ gestation was divided into a training set and a validation set. The training dataset was used to develop models from multivariable logistic regression analysis to determine whether addition of uterine artery pulsatility index (UtA-PI), umbilical artery PI (UA-PI), fetal middle cerebral artery PI (MCA-PI), maternal serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFLT) improved the performance of maternal factors and EFW in the prediction of delivery of SGA neonates. The models were then tested in the validation dataset to assess performance of screening.

Results In the training dataset, in the SGA group, compared to those with birthweight ≥10th percentile, the median multiple of the median (MoM) values of PLGF and MCA-PI were reduced, whereas UtA-PI, UA-PI and sFLT were increased. Multivariable regression analysis demonstrated that in the prediction of SGA <10th there were significant contributions from maternal factors, EFW Z-score, UtA-PI MoM, MCA-PI MoM and PlGF MoM. In the validation dataset, prediction of 90% of SGA neonates delivering within two weeks of assessment was achieved by a screen positive rate of 67% in screening by maternal factors, 23% by maternal factors and EFW and 21% by the addition of biomarkers; the respective values for prediction of SGA neonates delivering at any stage after assessment were 66%, 32% and 30%.

Conclusion: Addition of biomarkers of impaired placentation only marginally improves the predictive performance for delivery of SGA neonates achieved by maternal factors and fetal biometry at 35+0 - 36+6 weeks’ gestation.

KeywordsThird trimester screening; Small for gestational age; Uterine artery Doppler; Umbilical artery Doppler; Middle cerebral artery Doppler; Placental growth factor; Soluble fms-like tyrosine kinase-1
Year2019
JournalAmerican Journal of Obstetrics & Gynecology
Journal citation220 (5), pp. 486.e1-486.e11
PublisherElsevier
ISSN0002-9378
Digital Object Identifier (DOI)doi:10.1016/j.ajog.2019.01.227
Official URLhttps://doi.org/10.1016/j.ajog.2019.01.227
Publication dates
Online29 Jan 2019
Publication process dates
Accepted22 Jan 2019
Deposited10 Jun 2020
Accepted author manuscript
References

1. Lindqvist PG, Molin J. Does antenatal identification of small-for-gestational age fetuses
significantly improve their outcome? Ultrasound
Obstet Gynecol 2005;25:258–64
2. Gaccioli F, Aye ILMH, Sovio U, CharnockJones DS, Smith GCS. Screening for fetal
growth restriction using fetal biometry combined
with maternal biomarkers. Am J Obstet Gynecol
2018;218:S725–37.
3. Bais JMJ, Eskes M, Pel M, Bonsel GJ,
Bleker OP. Effectiveness of detection of intrauterine retardation by abdominal palpation as
screening test in a low-risk population: an
observational study. Eur J Obstet Gynecol
Reprod Biol 2004;116:164–9.
4. Lindhard A, Nielsen PV, Mouritsen LA,
Zachariassen A, Sørensen HU, Rosenø H. The
implications of introducing the symphysealfundal height-measurement. A prospective randomized controlled trial. Br J Obstet Gynaecol
1990;97:675–80.
5. Skovron ML, Berkowitz GS, Lapinski RH,
Kim JM, Chitkara U. Evaluation of early thirdtrimester ultrasound screening for intrauterine
growth retardation. J Ultrasound Med 1991;10:
153–9.
6. David C, Tagliavini G, Pilu G, Rudenholz A,
Bovicelli L. Receiver-operator characteristic
curves for the ultrasonographic prediction of
small-for-gestational-age fetuses in low-risk
pregnancies. Am J Obstet Gynecol 1996;174:
1037–42.
7. De Reu PA, Smits LJ, Oosterbaan HP,
Nijhuis JG. Value of a single early third trimester
fetal biometry for the prediction of birthweight
deviations in a low risk population. J Perinat Med
2008;36:324–9.
8. Di Lorenzo G, Monasta L, Ceccarello M,
Cecotti V, D’Ottavio G. Third trimester abdominal circumference, estimated fetal weight and
uterine artery Doppler for the identification of
newborns small and large for gestational age.
Eur J Obstet Gynecol Reprod Biol 2013;166:
133–8.
9. Souka AP, Papastefanou I, Pilalis A,
Michalitsi V, Kassanos D. Performance of thirdtrimester ultrasound for prediction of small-forgestational-age neonates and evaluation of
contingency screening policies. Ultrasound
Obstet Gynecol 2012;39:535–42.
10. Souka AP, Papastefanou I, Pilalis A,
Michalitsi V, Panagopoulos P, Kassanos D.
Performance of the ultrasound examination in
the early and late third trimester for the prediction
of birthweight deviations. Prenat Diagn 2013;33:
915–20.
11. Fadigas C, Saiid Y, Gonzalez R, Poon LC,
Nicolaides KH. Prediction of small for gestational
age neonates: screening by fetal biometry at 35-
37 weeks. Ultrasound Obstet Gynecol 2015;45:
559–65.
12. Bakalis S, Silva M, Akolekar R, Poon LC,
Nicolaides KH. Prediction of small for gestational
age neonates: screening by fetal biometry at
30e34 weeks. Ultrasound Obstet Gynecol
2015;45:551–8.
13. Bakalis S, Peeva G, Gonzalez R, Poon LC,
NicolaidesKH. Prediction of small-for-gestationalage neonates: screening by biophysical and
biochemical markers at 30-34 weeks. Ultrasound
Obstet Gynecol 2015;46:446–51.
14. Roma E, Arnau A, Berdala R, Bergos C,
Montesinos J, Figueras F. Ultrasound screening
for fetal growth restriction at 36 vs 32 weeks’
gestation: a randomized trial (ROUTE). Ultrasound Obstet Gynecol 2015;46:391–7.
15. Fadigas C, Guerra L, Garcia-Tizon
Larroca S, Poon LC, Nicolaides KH. Prediction
of small-for-gestational-age neonates:
screening by uterine artery Doppler and mean
arterial pressure at 35-37 weeks. Ultrasound
Obstet Gynecol 2015;45:715–21.
16. Triunfo S, Crispi F, Gratacos E, Figueras F.
Prediction of delivery of small-for-gestationalage neonates and adverse perinatal outcome
by fetoplacental Doppler at 37 weeks’ gestation. Ultrasound Obstet Gynecol 2017;49:
364–71.
17. Fadigas C, Peeva G, Mendez O, Poon LC,
Nicolaides KH. Prediction of small-forgestational-age neonates: screening by
placental growth factor and soluble fms-like
tyrosine kinase-1 at 35-37 weeks. Ultrasound
Obstet Gynecol 2015;46:191–7.
18. Hadlock FP, Harrist RB, Martinez-Poyer J.
In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991;
181:129–33.
19. Hammami A, Mazer Zumaeta A,
Syngelaki A, Akolekar R, Nicolaides KH. Ultrasonographic estimation of fetal weight: development of new model and assessment of
performance of previous models. Ultrasound
Obstet Gynecol 2018;52:35–43.
20. Albaiges G, Missfelder-Lobos H, Lees C,
Parra M, Nicolaides KH. One-stage screening
for pregnancy complications by color Doppler
assessment of the uterine arteries at 23
weeks’ gestation. Obstet Gynecol 2000;96:
559–64.
21. Ciobanu A, Wright A, Syngelaki A, Wright D,
Akolekar R, Nicolaides KH. Fetal Medicine
Foundation reference ranges for umbilical artery
and middle cerebral artery pulsatility index and
cerebroplacental ratio. Ultrasound Obstet
Gynecol 2018 Oct 24. https://doi.org/10.1002/
uog.20157.
22. Poon LC, Zymeri NA, Zamprakou A,
Syngelaki A, Nicolaides KH. Protocol for measurement of mean arterial pressure at 11-13
weeks’ gestation. Fetal Diagn Ther 2012;31:
42–8.
23. Robinson HP, Fleming JE. A critical evaluation of sonar crown-rump length measurements.
Br J Obstet Gynaecol 1975;82:702–10.
24. Snijders RJ, Nicolaides KH. Fetal biometry at
14-40 weeks’ gestation. Ultrasound Obstet
Gynecol 1994;4:34–48.
25. Nicolaides KH, Wright D, Syngelaki A,
Wright A, Akolekar R. Fetal Medicine Foundation
fetal and neonatal population weight charts. Ultrasound Obstet Gynecol 2018;52:44–51.
26. Panaitescu A, Ciobanu A, Syngelaki A,
Wright A, Wright D, Nicolaides KH. Screening for
pre-eclampsia at 35-37 weeks’ gestation. Ultrasound Obstet Gynecol 2018;52:501–6.
27. McIntire DD, Bloom SL, Casey BM,
Leveno KJ. Birthweight in relation to morbidity and mortality among newborn infants.
N Engl J Med. 1999; 340: 1234-1238
28. Deter RL, Lee W, Sangi-Haghpeykar H,
Kingdom J, Romero R. Third trimester growth
restriction patterns: individualized assessment
using a fetal growth pathology score. J Matern
Fetal Neonatal Med 2018;31:2155–63.
29. Akolekar R, Syngelaki A, Gallo DM,
Poon LC, Nicolaides KH. Umbilical and fetal
middle cerebral artery Doppler at 35-37 weeks’
gestation in the prediction of adverse perinatal
outcome. Ultrasound Obstet Gynecol 2015;46:
82–92.
30. Akolekar R, Ciobanu A, Zingler E,
Syngelaki A, Nicolaides KH. Cerebroplacental
ratio at 35-37 weeks’ gestation in the prediction
of adverse perinatal outcome. Am J Obstet
Gynecol 2019; submitted.
31. Nicolaides KH, Bilardo KM, Soothill PW,
Campbell S. Absence of end diastolic frequencies in the umbilical artery a sign of fetal
hypoxia and acidosis. BMJ 1988;297:1026–7.
32. Vyas S, Nicolaides KH, Bower S,
Campbell S. Middle cerebral artery flow velocity
waveforms in fetal hypoxaemia. Br J Obstet
Gynaecol 1990;97:797–803.
33. Bahado-Singh RO, Kovanci E, Jeffres A,
et al. The Doppler cerebroplacental ratio and
perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol 1999;180:750–6.
34. DeVore GR. The importance of the cerebroplacental ratio in the evaluation of fetal wellbeing in SGA and AGA fetuses. Am J Obstet
Gynecol 2015;213:5–15.
35. Prior T, Mullins E, Bennett P, Kumar S.
Prediction of intrapartum fetal compromise using the cerebroumbilical ratio: a prospective
observational study. Am J Obstet Gynecol
2013;208:124.e1–6.
36. Khalil AA, Morales-Rosello J, Morlando M,
et al. Is fetal cerebroplacental ratio an independent predictor of intrapartum fetal compromise
and neonatal unit admission? Am J Obstet
Gynecol 2015;213:54.e1–10.
37. Khalil AA, Morales-Rosello J, Elsadigg M,
et al. The association between fetal Doppler and
admission to neonatal unit at term. Am J Obstet
Gynecol 2015;213:57.e1–7
38. Khalil A, Morales-Rosello J, Khan N, et al. Is
cerebroplacental ratio a marker of impaired fetal
growth velocity and adverse pregnancy
outcome? Am J Obstet Gynecol 2017;216:606.
e1–10.
39. Deter RL, Lee W, Yeo L, Erez O,
Ramamurthy U, Naik M, Romero R. Individualized growth assessment: conceptual framework
and practical implementation for the evaluation
of fetal growth and neonatal growth outcome.
Am J Obstet Gynecol 2018;218:S656–78.
40. Nicolaides KH. Turning the pyramid of prenatal care. Fetal Diagn Ther 2011;29:183–96.
41. Wright D, Syngelaki A, Akolekar R, Poon LC,
Nicolaides KH. Competing risks model in
screening for preeclampsia by maternal characteristics and medical history. Am J Obstet
Gynecol 2015;213:62.e1–10.
42. O’Gorman N, Wright D, Syngelaki A, et al.
Competing risks model in screening for preeclampsia by maternal factors and biomarkers
at 11-13 weeks’ gestation. Am J Obstet Gynecol 2016;214:103.e1–12.
43. Rolnik DL, Wright D, Poon LC, et al. Aspirin
versus placebo in pregnancies at high risk for
preterm preeclampsia. N Engl J Med 2017;377:
613–22.
44. Wright D, Rolnik DL, Syngelaki A, et al.
Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin on length of stay in
the neonatal intensive care unit. Am J Obstet
Gynecol 2018;218:612.e1–6.
45. Wright D, Poon LC, Rolnik DL, et al. Aspirin
for Evidence-Based Preeclampsia Prevention
trial: influence of compliance on beneficial effect
of aspirin in prevention of preterm preeclampsia.
Am J Obstet Gynecol 2017;217:685.e1–5.
46. Poon LC, Wright D, Rolnik DL, et al. Aspirin
for Evidence-Based Preeclampsia Prevention
trial: effect of aspirin in prevention of preterm
preeclampsia in subgroups of women according
to their characteristics and medical and obstetrical history. Am J Obstet Gynecol 2017;217:
585.e1–5.
47. Roberge S, Bujold E, Nicolaides KH. Aspirin
for the prevention of preterm and term preeclampsia: systematic review and metaanalysis.
Am J Obstet Gynecol 2018;218:287–93
48. Tan MY, Poon LC, Rolnik DL, et al. Prediction and prevention of small-for-gestational-age
neonates: evidence from SPREE and ASPRE.
Ultrasound Obstet Gynecol 2018;52:52–9.
49. Poon LC, Lesmes C, Gallo DM, Akolekar R,
Nicolaides KH. Prediction of small-forgestational-age neonates: screening by biophysical and biochemical markers at 19-24
weeks. Ultrasound Obstet Gynecol 2015;46:
437–45.
50. Ciobanu A, Wright A, Panaitescu A,
Syngelaki A, Wright D, Nicolaides KH. Prediction
of imminent preeclampsia at 35-37 weeks’
gestation. Am J Obstet Gynecol 2019;
submitted.
51. McCowan LM, Figueras F, Anderson NH.
Evidence-based national guidelines for the
management of suspected fetal growth restriction: comparison, consensus, and controversy.
Am J Obstet Gynecol 2018;218:S855–68.
52. Figueras F, Caradeux J, Crispi F, Eixarch E,
Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J
Obstet Gynecol 2018;218:S790–802.

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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.
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.
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.
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.
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.
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.