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Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women.
Am J Obstet Gynecol 2017; 217(5):594.e1-594.e10AJ

Abstract

BACKGROUND

Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown.

OBJECTIVE

We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates.

STUDY DESIGN

Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days' and 22 weeks 6 days' gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated.

RESULTS

Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P < .0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66.

CONCLUSION

In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.

Authors+Show Affiliations

Departments of Obstetrics and Gynecology at the University of Pennsylvania School of Medicine, Philadelphia, PA. Electronic address: parry@mail.med.upenn.edu.Christiana Care Health System, Newark, DE.Indiana University School of Medicine, Indianapolis, IN.Feinberg School of Medicine, Northwestern University, Evanston, IL.Ohio State University College of Medicine, Columbus, OH.Case Western Reserve University School of Medicine, Cleveland, OH.University of Utah School of Medicine, Salt Lake City, UT.University of Pittsburgh School of Medicine, Pittsburgh, PA.College of Physicians and Surgeons, Columbia University, New York, NY.University of California, Irvine, School of Medicine, Irvine, CA; Miller Children's Hospital/Long Beach Memorial Medical Center, Long Beach, CA.Departments of Obstetrics and Gynecology at the University of Pennsylvania School of Medicine, Philadelphia, PA.Indiana University School of Medicine, Indianapolis, IN.Feinberg School of Medicine, Northwestern University, Evanston, IL.University of Utah School of Medicine, Salt Lake City, UT.University of Pittsburgh School of Medicine, Pittsburgh, PA.University of California, Irvine, School of Medicine, Irvine, CA; Miller Children's Hospital/Long Beach Memorial Medical Center, Long Beach, CA.RTI International, Research Triangle Park, NC.University of Texas Medical Branch, Galveston, TX.Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.RTI International, Research Triangle Park, NC.No affiliation info available

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28712949

Citation

Parry, Samuel, et al. "Role of Early Second-trimester Uterine Artery Doppler Screening to Predict Small-for-gestational-age Babies in Nulliparous Women." American Journal of Obstetrics and Gynecology, vol. 217, no. 5, 2017, pp. 594.e1-594.e10.
Parry S, Sciscione A, Haas DM, et al. Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women. Am J Obstet Gynecol. 2017;217(5):594.e1-594.e10.
Parry, S., Sciscione, A., Haas, D. M., Grobman, W. A., Iams, J. D., Mercer, B. M., ... Parker, C. B. (2017). Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women. American Journal of Obstetrics and Gynecology, 217(5), pp. 594.e1-594.e10. doi:10.1016/j.ajog.2017.06.013.
Parry S, et al. Role of Early Second-trimester Uterine Artery Doppler Screening to Predict Small-for-gestational-age Babies in Nulliparous Women. Am J Obstet Gynecol. 2017;217(5):594.e1-594.e10. PubMed PMID: 28712949.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women. AU - Parry,Samuel, AU - Sciscione,Anthony, AU - Haas,David M, AU - Grobman,William A, AU - Iams,Jay D, AU - Mercer,Brian M, AU - Silver,Robert M, AU - Simhan,Hyagriv N, AU - Wapner,Ronald J, AU - Wing,Deborah A, AU - Elovitz,Michal A, AU - Schubert,Frank P, AU - Peaceman,Alan, AU - Esplin,M Sean, AU - Caritis,Steve, AU - Nageotte,Michael P, AU - Carper,Benjamin A, AU - Saade,George R, AU - Reddy,Uma M, AU - Parker,Corette B, AU - ,, Y1 - 2017/07/13/ PY - 2016/12/15/received PY - 2017/06/04/revised PY - 2017/06/08/accepted PY - 2017/7/18/pubmed PY - 2017/11/29/medline PY - 2017/7/18/entrez KW - Doppler ultrasound KW - gestational hypertension KW - small for gestational age KW - spontaneous preterm birth KW - uterine artery SP - 594.e1 EP - 594.e10 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 217 IS - 5 N2 - BACKGROUND: Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. OBJECTIVE: We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. STUDY DESIGN: Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days' and 22 weeks 6 days' gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. RESULTS: Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P < .0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. CONCLUSION: In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/28712949/Role_of_early_second_trimester_uterine_artery_Doppler_screening_to_predict_small_for_gestational_age_babies_in_nulliparous_women_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(17)30749-4 DB - PRIME DP - Unbound Medicine ER -