Can Fetal Growth Velocity and First Trimester Maternal Biomarkers Improve the Prediction of Small-for-Gestational Age and Adverse Neonatal Outcome?
Background and Objectives: The aim of this study was to evaluate the value of adding fetal growth velocity and first trimester maternal biomarkers to baseline screening, for the prediction of small-for-gestational age (SGA) and adverse neonatal outcomes. Method: A retrospective cohort study was cond...
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| Veröffentlicht in: | Fetal diagnosis and therapy 2019-10, Vol.46 (4), p.274-284 |
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| creator | Hendrix, Manouk L.E. Bons, Judith A.P. Snellings, Roy R.G. Bekers, Otto van Kuijk, Sander M.J. Spaanderman, Marc E.A. Al-Nasiry, Salwan |
| description | Background and Objectives: The aim of this study was to evaluate the value of adding fetal growth velocity and first trimester maternal biomarkers to baseline screening, for the prediction of small-for-gestational age (SGA) and adverse neonatal outcomes. Method: A retrospective cohort study was conducted of singleton pregnancies in the Maastricht University Medical Centre between 2012 and 2016. The biomarkers PAPP-A, β-hCG, PlGF, and sFlt-1 were measured at 11–13 weeks of gestational age (GA) and two fetal growth scans were performed (18–22 and 30–34 weeks of GA). Differences in biomarkers and growth velocities were compared between appropriate-for-gestational age (AGA; birth weight percentile 10–90) and SGA (birth weight percentile |
| doi_str_mv | 10.1159/000499580 |
| format | Article |
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Method: A retrospective cohort study was conducted of singleton pregnancies in the Maastricht University Medical Centre between 2012 and 2016. The biomarkers PAPP-A, β-hCG, PlGF, and sFlt-1 were measured at 11–13 weeks of gestational age (GA) and two fetal growth scans were performed (18–22 and 30–34 weeks of GA). Differences in biomarkers and growth velocities were compared between appropriate-for-gestational age (AGA; birth weight percentile 10–90) and SGA (birth weight percentile <10). Combinations of the biomarkers and fetal growth velocity were added to baseline screening for the prediction of SGA and adverse neonatal outcome. Results: We included 296 singleton pregnancies. Compared to AGA (n = 251), SGA neonates (n = 45) had significantly lower growth velocities in the abdominal circumference (mm/week): 10.1 ± 0.98 versus 10.8 ± 0.98, p = 0.001. Compared with AGA, the SGA neonates had higher sFlt-1 multiples of the median (MoM): 0.89 (0.55) versus 0.76 (0.44), p = 0.023, and a higher sFlt-1/PlGF MoM ratio: 1.09 (1.03) versus 0.90 (0.64), p = 0.027. For a 15% false-positive rate, the prediction of SGA neonates increased from 44.8% for the baseline screening model to 56.5% after the addition of fetal growth velocities, and to 73.9% after the further addition of maternal biomarkers (PPV 9.6%, NPV 82.4%). The corresponding AUC for the three models were 0.722, 0.804, and 0.839, respectively. In addition, AGA neonates with reduced fetal growth velocity had more adverse neonatal outcomes compared to the AGA reference group (12.4 vs. 3.9%, p = 0.013). Conclusions: Combining fetal growth velocity with first trimester biomarkers resulted in a better prediction of SGA compared to baseline screening parameters alone. This approach could possibly result in reduced adverse neonatal outcomes in neonates, who are at a potential risk due to late mild placental dysfunction.</description><identifier>ISSN: 1015-3837</identifier><identifier>ISSN: 1421-9964</identifier><identifier>EISSN: 1421-9964</identifier><identifier>DOI: 10.1159/000499580</identifier><identifier>PMID: 31067557</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Adult ; Biological markers ; Biomarkers ; Female ; Fetal Development ; Fetus ; Gestational age ; Growth ; Humans ; Infant, Newborn ; Infant, Small for Gestational Age ; Methods ; Obstetrical research ; Original Paper ; Predictive Value of Tests ; Pregnancy ; Pregnancy Trimester, First ; Prenatal diagnosis ; Retrospective Studies</subject><ispartof>Fetal diagnosis and therapy, 2019-10, Vol.46 (4), p.274-284</ispartof><rights>2019 The Author(s) Published by S. Karger AG, Basel</rights><rights>2019 The Author(s) Published by S. Karger AG, Basel.</rights><rights>COPYRIGHT 2019 S. Karger AG</rights><rights>Copyright © 2019 by S. Karger AG, Basel 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c522t-4e5c3dcf715ecf9c00846574a54e42f00149651a7547fa2748bd38f00b208cac3</citedby><cites>FETCH-LOGICAL-c522t-4e5c3dcf715ecf9c00846574a54e42f00149651a7547fa2748bd38f00b208cac3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,2423,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31067557$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hendrix, Manouk L.E.</creatorcontrib><creatorcontrib>Bons, Judith A.P.</creatorcontrib><creatorcontrib>Snellings, Roy R.G.</creatorcontrib><creatorcontrib>Bekers, Otto</creatorcontrib><creatorcontrib>van Kuijk, Sander M.J.</creatorcontrib><creatorcontrib>Spaanderman, Marc E.A.</creatorcontrib><creatorcontrib>Al-Nasiry, Salwan</creatorcontrib><title>Can Fetal Growth Velocity and First Trimester Maternal Biomarkers Improve the Prediction of Small-for-Gestational Age and Adverse Neonatal Outcome?</title><title>Fetal diagnosis and therapy</title><addtitle>Fetal Diagn Ther</addtitle><description>Background and Objectives: The aim of this study was to evaluate the value of adding fetal growth velocity and first trimester maternal biomarkers to baseline screening, for the prediction of small-for-gestational age (SGA) and adverse neonatal outcomes. Method: A retrospective cohort study was conducted of singleton pregnancies in the Maastricht University Medical Centre between 2012 and 2016. The biomarkers PAPP-A, β-hCG, PlGF, and sFlt-1 were measured at 11–13 weeks of gestational age (GA) and two fetal growth scans were performed (18–22 and 30–34 weeks of GA). Differences in biomarkers and growth velocities were compared between appropriate-for-gestational age (AGA; birth weight percentile 10–90) and SGA (birth weight percentile <10). Combinations of the biomarkers and fetal growth velocity were added to baseline screening for the prediction of SGA and adverse neonatal outcome. Results: We included 296 singleton pregnancies. Compared to AGA (n = 251), SGA neonates (n = 45) had significantly lower growth velocities in the abdominal circumference (mm/week): 10.1 ± 0.98 versus 10.8 ± 0.98, p = 0.001. Compared with AGA, the SGA neonates had higher sFlt-1 multiples of the median (MoM): 0.89 (0.55) versus 0.76 (0.44), p = 0.023, and a higher sFlt-1/PlGF MoM ratio: 1.09 (1.03) versus 0.90 (0.64), p = 0.027. For a 15% false-positive rate, the prediction of SGA neonates increased from 44.8% for the baseline screening model to 56.5% after the addition of fetal growth velocities, and to 73.9% after the further addition of maternal biomarkers (PPV 9.6%, NPV 82.4%). The corresponding AUC for the three models were 0.722, 0.804, and 0.839, respectively. In addition, AGA neonates with reduced fetal growth velocity had more adverse neonatal outcomes compared to the AGA reference group (12.4 vs. 3.9%, p = 0.013). Conclusions: Combining fetal growth velocity with first trimester biomarkers resulted in a better prediction of SGA compared to baseline screening parameters alone. This approach could possibly result in reduced adverse neonatal outcomes in neonates, who are at a potential risk due to late mild placental dysfunction.</description><subject>Adult</subject><subject>Biological markers</subject><subject>Biomarkers</subject><subject>Female</subject><subject>Fetal Development</subject><subject>Fetus</subject><subject>Gestational age</subject><subject>Growth</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Small for Gestational Age</subject><subject>Methods</subject><subject>Obstetrical research</subject><subject>Original Paper</subject><subject>Predictive Value of Tests</subject><subject>Pregnancy</subject><subject>Pregnancy Trimester, First</subject><subject>Prenatal diagnosis</subject><subject>Retrospective Studies</subject><issn>1015-3837</issn><issn>1421-9964</issn><issn>1421-9964</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>M--</sourceid><sourceid>EIF</sourceid><recordid>eNptklFrFDEUhQdRbK0--C4SKIg-TE1mksnMS2Vd3bVQreDqa8hmbnZjM5M1yaz0d_iHzbh16UIJJOHkO4fcy82y5wSfEcKatxhj2jSsxg-yY0ILkjdNRR-mOyYsL-uSH2VPQviZsJqX1ePsqCS44ozx4-zPVPZoBlFaNPfud1yjH2CdMvEGyb5FM-NDRAtvOggRPPos094n-L1xnfTX4AO66DbebQHFNaCvHlqjonE9chp966S1uXY-nye7HOVknazgX_ak3SY7oC-Q5PEDV0NUroN3T7NHWtoAz27Pk-z77ONi-im_vJpfTCeXuWJFEXMKTJWt0pwwULpRqTpaMU4lo0ALjTGhTcWI5IxyLQtO62Vb1klfFrhWUpUn2fkudzMsO2gV9NFLKzapWulvhJNGHL70Zi1WbiuqmqdG0hTw-jbAu19DKlF0JiiwVvbghiCKoiQN5XXVJPR0h66kBWF67VKiGnExqcoG16zAY-DZPVRaLXRGuR60SfqB4dUdwxqkjevg7DC2OhyCb3ag8i4ED3pfJsFiHCKxH6LEvrzblz35f2oS8GIHXEu_Ar8H9v7Te59nHxY7QmxaXf4F06jWfw</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Hendrix, Manouk L.E.</creator><creator>Bons, Judith A.P.</creator><creator>Snellings, Roy R.G.</creator><creator>Bekers, Otto</creator><creator>van Kuijk, Sander M.J.</creator><creator>Spaanderman, Marc E.A.</creator><creator>Al-Nasiry, Salwan</creator><general>S. Karger AG</general><scope>M--</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20191001</creationdate><title>Can Fetal Growth Velocity and First Trimester Maternal Biomarkers Improve the Prediction of Small-for-Gestational Age and Adverse Neonatal Outcome?</title><author>Hendrix, Manouk L.E. ; Bons, Judith A.P. ; Snellings, Roy R.G. ; Bekers, Otto ; van Kuijk, Sander M.J. ; Spaanderman, Marc E.A. ; Al-Nasiry, Salwan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c522t-4e5c3dcf715ecf9c00846574a54e42f00149651a7547fa2748bd38f00b208cac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Biological markers</topic><topic>Biomarkers</topic><topic>Female</topic><topic>Fetal Development</topic><topic>Fetus</topic><topic>Gestational age</topic><topic>Growth</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infant, Small for Gestational Age</topic><topic>Methods</topic><topic>Obstetrical research</topic><topic>Original Paper</topic><topic>Predictive Value of Tests</topic><topic>Pregnancy</topic><topic>Pregnancy Trimester, First</topic><topic>Prenatal diagnosis</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hendrix, Manouk L.E.</creatorcontrib><creatorcontrib>Bons, Judith A.P.</creatorcontrib><creatorcontrib>Snellings, Roy R.G.</creatorcontrib><creatorcontrib>Bekers, Otto</creatorcontrib><creatorcontrib>van Kuijk, Sander M.J.</creatorcontrib><creatorcontrib>Spaanderman, Marc E.A.</creatorcontrib><creatorcontrib>Al-Nasiry, Salwan</creatorcontrib><collection>Karger Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Fetal diagnosis and therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hendrix, Manouk L.E.</au><au>Bons, Judith A.P.</au><au>Snellings, Roy R.G.</au><au>Bekers, Otto</au><au>van Kuijk, Sander M.J.</au><au>Spaanderman, Marc E.A.</au><au>Al-Nasiry, Salwan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can Fetal Growth Velocity and First Trimester Maternal Biomarkers Improve the Prediction of Small-for-Gestational Age and Adverse Neonatal Outcome?</atitle><jtitle>Fetal diagnosis and therapy</jtitle><addtitle>Fetal Diagn Ther</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>46</volume><issue>4</issue><spage>274</spage><epage>284</epage><pages>274-284</pages><issn>1015-3837</issn><issn>1421-9964</issn><eissn>1421-9964</eissn><abstract>Background and Objectives: The aim of this study was to evaluate the value of adding fetal growth velocity and first trimester maternal biomarkers to baseline screening, for the prediction of small-for-gestational age (SGA) and adverse neonatal outcomes. Method: A retrospective cohort study was conducted of singleton pregnancies in the Maastricht University Medical Centre between 2012 and 2016. The biomarkers PAPP-A, β-hCG, PlGF, and sFlt-1 were measured at 11–13 weeks of gestational age (GA) and two fetal growth scans were performed (18–22 and 30–34 weeks of GA). Differences in biomarkers and growth velocities were compared between appropriate-for-gestational age (AGA; birth weight percentile 10–90) and SGA (birth weight percentile <10). Combinations of the biomarkers and fetal growth velocity were added to baseline screening for the prediction of SGA and adverse neonatal outcome. Results: We included 296 singleton pregnancies. Compared to AGA (n = 251), SGA neonates (n = 45) had significantly lower growth velocities in the abdominal circumference (mm/week): 10.1 ± 0.98 versus 10.8 ± 0.98, p = 0.001. Compared with AGA, the SGA neonates had higher sFlt-1 multiples of the median (MoM): 0.89 (0.55) versus 0.76 (0.44), p = 0.023, and a higher sFlt-1/PlGF MoM ratio: 1.09 (1.03) versus 0.90 (0.64), p = 0.027. For a 15% false-positive rate, the prediction of SGA neonates increased from 44.8% for the baseline screening model to 56.5% after the addition of fetal growth velocities, and to 73.9% after the further addition of maternal biomarkers (PPV 9.6%, NPV 82.4%). The corresponding AUC for the three models were 0.722, 0.804, and 0.839, respectively. In addition, AGA neonates with reduced fetal growth velocity had more adverse neonatal outcomes compared to the AGA reference group (12.4 vs. 3.9%, p = 0.013). Conclusions: Combining fetal growth velocity with first trimester biomarkers resulted in a better prediction of SGA compared to baseline screening parameters alone. This approach could possibly result in reduced adverse neonatal outcomes in neonates, who are at a potential risk due to late mild placental dysfunction.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>31067557</pmid><doi>10.1159/000499580</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Biological markers Biomarkers Female Fetal Development Fetus Gestational age Growth Humans Infant, Newborn Infant, Small for Gestational Age Methods Obstetrical research Original Paper Predictive Value of Tests Pregnancy Pregnancy Trimester, First Prenatal diagnosis Retrospective Studies |
| title | Can Fetal Growth Velocity and First Trimester Maternal Biomarkers Improve the Prediction of Small-for-Gestational Age and Adverse Neonatal Outcome? |
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