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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 Obstet Gynecol. 2019 May; 53(5):630-637.UO

Abstract

OBJECTIVE

To assess the additive value of fetal growth velocity between 32 and 36 weeks' gestation to the performance of ultrasonographic estimated fetal weight (EFW) at 35 + 0 to 36 + 6 weeks' gestation for prediction of delivery of a small-for-gestational-age (SGA) neonate and adverse perinatal outcome.

METHODS

This was a prospective study of 14 497 singleton pregnancies undergoing routine ultrasound examination at 30 + 0 to 34 + 6 and at 35 + 0 to 36 + 6 weeks' gestation. Multivariable logistic regression analysis was used to determine whether addition of growth velocity, defined as the difference in EFW Z-score or abdominal circumference (AC) Z-score between the early and late third-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, first, delivery of a SGA neonate with birth weight < 10th and < 3rd percentiles within 2 weeks and at any stage after assessment and, second, a composite of adverse perinatal outcome, defined as stillbirth, neonatal death or admission to the neonatal unit for ≥ 48 h.

RESULTS

Multivariable logistic regression analysis demonstrated that significant contributors to the prediction of a SGA neonate were EFW Z-score at 35 + 0 to 36 + 6 weeks' gestation, fetal growth velocity, by either AC Z-score or EFW Z-score, and maternal risk factors. The area under the receiver-operating characteristics curve (AUC) and detection rate (DR), at a 10% screen-positive rate, for prediction of a SGA neonate < 10th percentile born within 2 weeks after assessment achieved by EFW Z-score at 35 + 0 to 36 + 6 weeks (AUC, 0.938 (95% CI, 0.928-0.947); DR, 80.7% (95% CI, 77.6-83.9%)) were not significantly improved by addition of EFW growth velocity and maternal risk factors (AUC, 0.941 (95% CI, 0.932-0.950); P = 0.061; DR, 82.5% (95% CI, 79.4-85.3%)). Similar results were obtained when growth velocity was defined by AC rather than EFW. Similarly, there was no significant improvement in the AUC and DR, at a 10% screen-positive rate, for prediction of a SGA neonate < 10th percentile born at any stage after assessment or a SGA neonate < 3rd percentile born within 2 weeks or at any stage after assessment, achieved by EFW Z-score at 35 + 0 to 36 + 6 weeks by addition of maternal factors and either EFW growth velocity or 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 delivery of a neonate with birth weight < 10th and < 3rd percentiles and adverse perinatal outcome was provided by EFW Z-score at 35 + 0 to 36 + 6 weeks, but not by AC growth velocity < 1st decile.

CONCLUSION

The predictive performance of EFW at 35 + 0 to 36 + 6 weeks' gestation for delivery of a SGA neonate and adverse perinatal outcome is not improved by addition of estimated growth velocity between 32 and 36 weeks' gestation. 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 Unit, Medway Maritime Hospital, Gillingham, 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)

Evaluation Study
Journal Article

Language

eng

PubMed ID

30912210

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 32 and 36 Weeks." Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol. 53, no. 5, 2019, pp. 630-637.
Ciobanu A, Anthoulakis 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 32 and 36 weeks. Ultrasound Obstet Gynecol. 2019;53(5):630-637.
Ciobanu, A., Anthoulakis, 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 32 and 36 weeks. Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 53(5), 630-637. https://doi.org/10.1002/uog.20267
Ciobanu A, et al. 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 Obstet Gynecol. 2019;53(5):630-637. PubMed PMID: 30912210.
* 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 32 and 36 weeks. AU - Ciobanu,A, AU - Anthoulakis,C, AU - Syngelaki,A, AU - Akolekar,R, AU - Nicolaides,K H, Y1 - 2019/04/08/ PY - 2019/02/19/received PY - 2019/03/12/revised PY - 2019/03/14/accepted PY - 2019/3/27/pubmed PY - 2019/12/25/medline PY - 2019/3/27/entrez KW - estimated fetal weight KW - growth charts KW - growth velocity KW - small-for-gestational age KW - third-trimester screening SP - 630 EP - 637 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 - 5 N2 - OBJECTIVE: To assess the additive value of fetal growth velocity between 32 and 36 weeks' gestation to the performance of ultrasonographic estimated fetal weight (EFW) at 35 + 0 to 36 + 6 weeks' gestation for prediction of delivery of a small-for-gestational-age (SGA) neonate and adverse perinatal outcome. METHODS: This was a prospective study of 14 497 singleton pregnancies undergoing routine ultrasound examination at 30 + 0 to 34 + 6 and at 35 + 0 to 36 + 6 weeks' gestation. Multivariable logistic regression analysis was used to determine whether addition of growth velocity, defined as the difference in EFW Z-score or abdominal circumference (AC) Z-score between the early and late third-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, first, delivery of a SGA neonate with birth weight < 10th and < 3rd percentiles within 2 weeks and at any stage after assessment and, second, a composite of adverse perinatal outcome, defined as stillbirth, neonatal death or admission to the neonatal unit for ≥ 48 h. RESULTS: Multivariable logistic regression analysis demonstrated that significant contributors to the prediction of a SGA neonate were EFW Z-score at 35 + 0 to 36 + 6 weeks' gestation, fetal growth velocity, by either AC Z-score or EFW Z-score, and maternal risk factors. The area under the receiver-operating characteristics curve (AUC) and detection rate (DR), at a 10% screen-positive rate, for prediction of a SGA neonate < 10th percentile born within 2 weeks after assessment achieved by EFW Z-score at 35 + 0 to 36 + 6 weeks (AUC, 0.938 (95% CI, 0.928-0.947); DR, 80.7% (95% CI, 77.6-83.9%)) were not significantly improved by addition of EFW growth velocity and maternal risk factors (AUC, 0.941 (95% CI, 0.932-0.950); P = 0.061; DR, 82.5% (95% CI, 79.4-85.3%)). Similar results were obtained when growth velocity was defined by AC rather than EFW. Similarly, there was no significant improvement in the AUC and DR, at a 10% screen-positive rate, for prediction of a SGA neonate < 10th percentile born at any stage after assessment or a SGA neonate < 3rd percentile born within 2 weeks or at any stage after assessment, achieved by EFW Z-score at 35 + 0 to 36 + 6 weeks by addition of maternal factors and either EFW growth velocity or 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 delivery of a neonate with birth weight < 10th and < 3rd percentiles and adverse perinatal outcome was provided by EFW Z-score at 35 + 0 to 36 + 6 weeks, but not by AC growth velocity < 1st decile. CONCLUSION: The predictive performance of EFW at 35 + 0 to 36 + 6 weeks' gestation for delivery of a SGA neonate and adverse perinatal outcome is not improved by addition of estimated growth velocity between 32 and 36 weeks' gestation. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. SN - 1469-0705 UR - https://www.unboundmedicine.com/medline/citation/30912210/Prediction_of_small_for_gestational_age_neonates_at_35_37_weeks'_gestation:_contribution_of_maternal_factors_and_growth_velocity_between_32_and_36_weeks_ L2 - https://doi.org/10.1002/uog.20267 DB - PRIME DP - Unbound Medicine ER -