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Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 20 and 36 weeks.
Ultrasound Obstet Gynecol. 2019 Apr; 53(4):488-495.UO

Abstract

OBJECTIVES

To evaluate the performance of ultrasonographic estimated fetal weight (EFW) at 35 + 0 to 36 + 6 weeks' gestation in the prediction of delivery of a small-for-gestational-age (SGA) neonate and assess the additive value of, first, maternal risk factors and, second, fetal growth velocity between 20 and 36 weeks' gestation in improving such prediction.

METHODS

This was a prospective study of 44 043 singleton pregnancies undergoing routine ultrasound examination at 19 + 0 to 23 + 6 and at 35 + 0 to 36 + 6 weeks' gestation. Multivariable logistic regression analysis was used to determine whether addition of maternal risk factors and growth velocity, the latter defined as the difference in EFW Z-score or fetal abdominal circumference (AC) Z-score between the third- and second-trimester scans divided by the time interval between the scans, improved the performance of EFW Z-score at 35 + 0 to 36 + 6 weeks in the prediction of delivery of a SGA neonate with birth weight < 10th and < 3rd percentiles within 2 weeks and at any stage after assessment.

RESULTS

Screening by EFW Z-score at 35 + 0 to 36 + 6 weeks' gestation predicted 63.4% (95% CI, 62.0-64.7%) of neonates with birth weight < 10th percentile and 74.2% (95% CI, 72.2-76.1%) of neonates with birth weight < 3rd percentile born at any stage after assessment, at a screen-positive rate of 10%. The respective values for SGA neonates born within 2 weeks after assessment were 76.8% (95% CI, 74.4-79.0%) and 81.3% (95% CI, 78.2-84.0%). For a desired 90% detection rate of SGA neonate delivered at any stage after assessment, the necessary screen-positive rate would be 33.7% for SGA < 10th percentile and 24.4% for SGA < 3rd percentile. Multivariable logistic regression analysis demonstrated that, in the prediction of a SGA neonate with birth weight < 10th and < 3rd percentiles, there was a significant contribution from EFW Z-score at 35 + 0 to 36 + 6 weeks' gestation, maternal risk factors and AC growth velocity, but not EFW growth velocity. However, the area under the receiver-operating characteristics curve for prediction of delivery of a SGA neonate by screening with maternal risk factors and EFW Z-score was not improved by addition of AC growth velocity.

CONCLUSION

Screening for SGA neonates by EFW at 35 + 0 to 36 + 6 weeks' gestation and use of the 10th percentile as the cut-off predicts 63% of affected neonates. Prediction of 90% of SGA neonates necessitates classification of about 35% of the population as being screen positive. The predictive performance of EFW is not improved by addition of estimated growth velocity between the second and third trimesters of pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Authors+Show Affiliations

Fetal Medicine Research Institute, King's College Hospital, London, UK.Fetal Medicine Research Institute, King's College Hospital, London, UK.Fetal Medicine Research Institute, King's College Hospital, London, UK.Fetal Medicine Unit, Medway Maritime Hospital, Gillingham, UK. Institute of Medical Sciences, Canterbury Christ Church University, Chatham, UK.Fetal Medicine Research Institute, King's College Hospital, London, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30779239

Citation

Ciobanu, A, et al. "Prediction of Small-for-gestational-age Neonates at 35-37 Weeks' Gestation: Contribution of Maternal Factors and Growth Velocity Between 20 and 36 Weeks." Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol. 53, no. 4, 2019, pp. 488-495.
Ciobanu A, Formuso C, Syngelaki A, et al. Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 20 and 36 weeks. Ultrasound Obstet Gynecol. 2019;53(4):488-495.
Ciobanu, A., Formuso, C., Syngelaki, A., Akolekar, R., & Nicolaides, K. H. (2019). Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 20 and 36 weeks. Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 53(4), 488-495. https://doi.org/10.1002/uog.20243
Ciobanu A, et al. Prediction of Small-for-gestational-age Neonates at 35-37 Weeks' Gestation: Contribution of Maternal Factors and Growth Velocity Between 20 and 36 Weeks. Ultrasound Obstet Gynecol. 2019;53(4):488-495. PubMed PMID: 30779239.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of small-for-gestational-age neonates at 35-37 weeks' gestation: contribution of maternal factors and growth velocity between 20 and 36 weeks. AU - Ciobanu,A, AU - Formuso,C, AU - Syngelaki,A, AU - Akolekar,R, AU - Nicolaides,K H, PY - 2019/01/30/received PY - 2019/02/13/revised PY - 2019/02/15/accepted PY - 2019/2/20/pubmed PY - 2019/5/2/medline PY - 2019/2/20/entrez KW - estimated fetal weight KW - growth velocity KW - pyramid of pregnancy care KW - small-for-gestational age KW - third-trimester screening SP - 488 EP - 495 JF - Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology JO - Ultrasound Obstet Gynecol VL - 53 IS - 4 N2 - OBJECTIVES: To evaluate the performance of ultrasonographic estimated fetal weight (EFW) at 35 + 0 to 36 + 6 weeks' gestation in the prediction of delivery of a small-for-gestational-age (SGA) neonate and assess the additive value of, first, maternal risk factors and, second, fetal growth velocity between 20 and 36 weeks' gestation in improving such prediction. METHODS: This was a prospective study of 44 043 singleton pregnancies undergoing routine ultrasound examination at 19 + 0 to 23 + 6 and at 35 + 0 to 36 + 6 weeks' gestation. Multivariable logistic regression analysis was used to determine whether addition of maternal risk factors and growth velocity, the latter defined as the difference in EFW Z-score or fetal abdominal circumference (AC) Z-score between the third- and second-trimester scans divided by the time interval between the scans, improved the performance of EFW Z-score at 35 + 0 to 36 + 6 weeks in the prediction of delivery of a SGA neonate with birth weight < 10th and < 3rd percentiles within 2 weeks and at any stage after assessment. RESULTS: Screening by EFW Z-score at 35 + 0 to 36 + 6 weeks' gestation predicted 63.4% (95% CI, 62.0-64.7%) of neonates with birth weight < 10th percentile and 74.2% (95% CI, 72.2-76.1%) of neonates with birth weight < 3rd percentile born at any stage after assessment, at a screen-positive rate of 10%. The respective values for SGA neonates born within 2 weeks after assessment were 76.8% (95% CI, 74.4-79.0%) and 81.3% (95% CI, 78.2-84.0%). For a desired 90% detection rate of SGA neonate delivered at any stage after assessment, the necessary screen-positive rate would be 33.7% for SGA < 10th percentile and 24.4% for SGA < 3rd percentile. Multivariable logistic regression analysis demonstrated that, in the prediction of a SGA neonate with birth weight < 10th and < 3rd percentiles, there was a significant contribution from EFW Z-score at 35 + 0 to 36 + 6 weeks' gestation, maternal risk factors and AC growth velocity, but not EFW growth velocity. However, the area under the receiver-operating characteristics curve for prediction of delivery of a SGA neonate by screening with maternal risk factors and EFW Z-score was not improved by addition of AC growth velocity. CONCLUSION: Screening for SGA neonates by EFW at 35 + 0 to 36 + 6 weeks' gestation and use of the 10th percentile as the cut-off predicts 63% of affected neonates. Prediction of 90% of SGA neonates necessitates classification of about 35% of the population as being screen positive. The predictive performance of EFW is not improved by addition of estimated growth velocity between the second and third trimesters of pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. SN - 1469-0705 UR - https://www.unboundmedicine.com/medline/citation/30779239/Prediction_of_small_for_gestational_age_neonates_at_35_37_weeks'_gestation:_contribution_of_maternal_factors_and_growth_velocity_between_20_and_36_weeks_ L2 - https://doi.org/10.1002/uog.20243 DB - PRIME DP - Unbound Medicine ER -