Predictive values of clinical parameters and biophysical and biochemical markers in the first trimester for the detection of small-for-gestational age fetuses

Irene Reali Antunes; Guilherme Antonio Rago Lobo; Edward Araujo Júnior; David Baptista da Silva Pares

doi:10.1515/jpm-2020-0203

Article

Predictive values of clinical parameters and biophysical and biochemical markers in the first trimester for the detection of small-for-gestational age fetuses

Irene Reali Antunes , Guilherme Antonio Rago Lobo , Edward Araujo Júnior and David Baptista da Silva Pares

Published/Copyright: August 31, 2020

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From the journal Journal of Perinatal Medicine Volume 49 Issue 1

Abstract

Objectives

To evaluate the predictive values of maternal characteristics, biophysical parameters (mean arterial pressure [MAP] and Doppler uterine artery measurements), and biochemical parameters (pregnancy-associated plasma protein A [PAPP-A] and placental growth factor [PlGF]) alone and in association for small-for-gestational age (SGA) fetuses.

Methods

We performed a retrospective analysis of a prospective observational study that evaluated 615 pregnant women in the first trimester using ultrasonography. For all the women, information regarding clinical and obstetric histories, MAP, and uterine artery mean pulsatility index (UtA-PI), and blood samples for analysis of biochemical markers (PAPP-A and PlGF) were obtained. The patients were grouped according to birth weight as follows: group I (n=571), >10th percentile (control); group II (n=44), <10th percentile; and group III (n=34), <5th percentile. The predictive values of the variables for the detection of SGA fetuses were calculated using a logistic regression model and an analysis of the area under the receiver-operating characteristic curve (AUC).

Results

The sensitivity rates of the maternal characteristics, biophysical markers (MAP and UtA-PI), biochemical markers (PAPP-A and PlGF), and the association between them were: 23.3, 32.5, 25, and 30% respectively, at a false-positive (FP) rate of 10%, in group II and 26.5, 26.5, 23.5, and 23.5%, respectively, at a FP rate of 10% in group III.

Conclusions

The predictive performances of the combination of maternal characteristics and biophysical and biochemical parameters were unsatisfactory, with a slight improvement in the predictive capacity for SGA fetuses <10th percentile.

Keywords: Doppler; first trimester; placental growth factor (PlGF); pregnancy-associated plasma protein A (PAPP-A); screening; small for gestational age

Corresponding author: Prof. Edward Araujo Júnior, PhD, Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, CEP 05089-030 São Paulo, SP, Brazil. Phone/Fax: +55 11 37965944, E-mail: araujojred@terra.com.br

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was approved by the Research Ethics Committee of UNIFESP.

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Received: 2020-05-07

Accepted: 2020-08-07

Published Online: 2020-08-31

Published in Print: 2021-01-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2020-0203

Keywords for this article

Doppler; first trimester; placental growth factor (PlGF); pregnancy-associated plasma protein A (PAPP-A); screening; small for gestational age