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首页> 外文期刊>American Journal of Obstetrics and Gynecology >First-trimester prediction of small-for-gestational age neonates incorporating fetal Doppler parameters and maternal characteristics
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First-trimester prediction of small-for-gestational age neonates incorporating fetal Doppler parameters and maternal characteristics

机译：结合胎儿多普勒参数和孕产妇特征的小胎龄新生儿的早孕预测

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Objective First-trimester screening for subsequent delivery of a small-for-gestational-age (SGA) infant typically focuses on maternal risk factors and uterine artery (UtA) Doppler. Our aim is to test if incorporation of fetal umbilical artery (UA) and ductus venosus (DV) Doppler improves SGA prediction. Study Design Prospective screening study of singletons at 11-14 weeks. Maternal characteristics, serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin are ascertained and UtA Doppler, UA, and DV Doppler studies are performed. These parameters are tested for their ability to predict subsequent delivery of a SGA infant. Results Among 2267 enrolled women, 191 (8.4%) deliver an SGA infant. At univariate analysis women with SGA neonates are younger, more frequently African-American (AA), nulliparous, more likely to smoke, have lower PAPP-A and free β-human chorionic gonadotropin levels. They have a higher incidence of UtA Doppler bilateral notching, higher mean UtA Doppler-pulsatility index z-scores (P <.001) and UA pulsatility index z-scores (P =.03), but no significant difference in DV-pulsatility index z-scores or in the incidence of abnormal qualitative UA and DV patterns. Multivariate logistic regression analysis identifies nulliparity and AA ethnicity (P <.001), PAPP-A multiple of the median and bilateral notching (P <.05) as determinants of SGA infant. Predictive sensitivity was low; receiver operating characteristic curve analysis yields areas under the curve of 0.592 (95% confidence interval, 0.548-0.635) for the combination of UtA Doppler and UA pulsatility index z-scores. Conclusion Delivery of a SGA infant is most frequent in nulliparous women of AA ethnicity. Despite the statistical association with UtA Doppler first-trimester SGA prediction is poor and not improved by the incorporation of fetal Doppler.
机译：目的进行小胎龄（SGA）婴儿后续分娩的早孕筛查通常侧重于孕产妇危险因素和子宫动脉（UtA）多普勒检查。我们的目的是测试合并胎儿脐动脉（UA）和静脉导管（DV）多普勒是否能改善SGA预测。研究设计对11-14周单身人士的前瞻性筛选研究。确定孕产妇特征，妊娠相关血浆蛋白-A（PAPP-A）和游离β-人绒毛膜促性腺激素的血清浓度，并进行UtA多普勒，UA和DV多普勒研究。测试这些参数预测SGA婴儿随后分娩的能力。结果在2267名登记的妇女中，有191名（8.4％）分娩了SGA婴儿。在单变量分析中，患有SGA的新生儿较年轻，非裔美国人（AA）较多，无产，吸烟的可能性较高，PAPP-A和游离β-人绒毛膜促性腺激素水平较低。他们的UtA多普勒双侧切口发生率更高，平均UtA多普勒搏动指数z得分（P <.001）和UA搏动指数z得分（P = .03）更高，但DV搏动指数没有显着差异z得分或异常UA和DV模式的发生率。多元logistic回归分析确定无效和AA种族（P <.001），中位和双侧切口的PAPP-A倍数（P <.05）是SGA婴儿的决定因素。预测灵敏度低;接收机工作特性曲线分析得出UtA多普勒和UA搏动指数z得分的组合曲线下面积为0.592（95％置信区间，0.548-0.635）。结论在AA族的未生育妇女中，SGA婴儿的分娩最频繁。尽管与UtA多普勒妊娠的统计相关性很高，但SGA的预测仍然很差，并且不能通过合并胎儿多普勒而得到改善。

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