Which ultrasound or biochemical markers are independent predictors of small-for-gestational age?
Which ultrasound or biochemical markers are independent predictors of small-for-gestational age?
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DOI：
10.1002/uog.6455
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发表时间：
2009-09-01
影响因子：
7.1
通讯作者：
Lau, T. K.
中科院分区：
文献类型：
--
作者：
Law, L. W.;Leung, T. Y.;Lau, T. K.
目的探讨早期和中期超声或生化指标对胎儿生长和小于胎龄儿（SGA）的预测价值。于11 ~ 13 + 6周测量胎儿顶臀长（CRL）、胎盘体积（普拉夫）、子宫动脉搏动指数（UtA-PI）、孕妇血清妊娠相关血浆蛋白-A（PAPP-A）和游离β-人绒毛膜促性腺激素（β-hCG）水平。在18-22周测量胎儿双顶径、股骨长、腹围和胎头围、普拉夫和UtA-PI。将所有标记物转换为胎龄特异性Z评分或中位数倍数（MoM）。出生体重也转换为Z-分数使用个性化的胎龄相关的最佳重量的基础上，当地推导的诺模图。结果单因素分析显示，除游离β-hCG外，所有指标均与出生体重Z评分相关。多元线性回归分析显示，妊娠早期只有普拉夫、UtA-PI和CRL，妊娠中期只有普拉夫和UtA-PI是独立的指标。Logistic回归分析显示，普拉夫是SGA的唯一独立预测因子，普拉夫和UtA-PI是SGA的独立预测因子。这些早期和中期妊娠标志物预测SGA的敏感性分别为41%和45%，假阳性率为20%。结论在各种已知的超声和生化指标中，只有孕早期普拉夫和孕中期普拉夫和UtA-PI是SGA的独立预测因子。Copyright（C）2009 ISUOG.由John Wiley & Sons有限公司出版
Objectives To investigate which ultrasound or biochemical markers in both the first and the second trimesters are the best predictors for fetal growth and small-for-gestational age (SGA).Methods This was a prospective study of 619 Chinese women with a singleton pregnancy. At 11 to 13 + 6 weeks, fetal crown-rump length (CRL), placental volume (PlaV), uterine artery pulsatility index (UtA-PI), and the maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG) were measured. Fetal biparietal diameter, femur length, abdominal and bead circumference, PlaV and UtA-PI were then measured at 18-22 weeks. All markers were transformed to gestational age-specific Z-scores or multiples of the median (MoM). Birth weights were also transformed to Z-scores using the individualized gestational age-related optimal weight based on a locally derived nomogram. The relationship between all markers and the customized birth weight were examined, and their predictive powers for SGA were examined by regression analysis.Results Univariate analysis revealed that all markers except free beta-hCG correlated with birth weight Z-score. After multiple linear regression analysis, only PlaV, UtA-PI and CRL in the first trimester, and PlaV and UtA-PI in the second trimester, stood out as independent markers. Logistic regression analysis showed that PlaV was the only independent first-trimester predictor of SGA, and in the second trimester both PlaV and UtA-PI were independent predictors. The sensitivity of these first- and second-trimester markers in predicting SGA were 41% and 45%, respectively, at a false-positive rate of 20%. Combining them did not significantly improve prediction of SGA.Conclusions Among the various known ultrasound and biochemical markers, only the first-trimester PlaV and the second-trimester PlaV plus UtA-PI are independent predictors for SGA. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.