Fetal growth restriction: First trimester abnormal analytes, second trimester uterine artery—complementary or redundant?

• Published in: Journal of obstetrics and gynaecology Canada Vol. 42; no. 5; p. 677
• Main Authors: Jones, Sara, Aviram, Amir, Porto, Ludmila, Huang, Tianhua, Barrett, Jon, Mei-Dan, Elad
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-05-2020
• Subjects: fetal growth restriction; first trimester screening; perinatal risk assessment; uterine artery doppler; uterine artery doppler; fetal growth restriction; first trimester screening; perinatal risk assessment
• ISSN: 1701-2163
• DOI: 10.1016/j.jogc.2020.02.052

To assess the utility of uterine artery Doppler study and the risk of fetal growth restriction (FGR) in the presence of abnormal serum analytes in the first trimester screening (FTS).
We conducted a retrospective cohort study of women who had a placental study following abnormal serum analytes in FTS. FTS included PAPP-A, PlGF, free β-hCG and AFP. Placental ultrasound was conducted during the second trimester and included the gestational age-adjusted mean uterine artery pulsatility index (UtA-PI). Outcomes of pregnancies with elevated UtA-PI (MoM >95% percentile) were compared with those of pregnancies with normal UtA-PI (≤95% percentile). ROC curve was calculated to assess the utility of uterine artery Doppler study in the prediction of FGR.
546 women were included. Of those, 52 (9.5%) had elevated UtA-PI. This group had higher mean pre-pregnancy BMI and higher rates of abnormal PAPP-A and ≥2 abnormal analytes. All other characteristics were similar between groups. Neonates of women with elevated UtA-PI had lower mean birth weight (BW), and higher rates of BW <3rd, 5th and 10th percentile. The area under the ROC curve for predicting FGR <3rd percentile was 0.690 for UtA-PI, 0.643 for PAPP-A, and 0.720 for their combination, with overlapping confidence intervals, indicating that the combination did not significantly improve the predictability of FGR <3rd percentile. Similar patterns emerged for FGR <5th and 10th percentile.
In women at high risk for FGR based on abnormal FTS analytes, elevated UtA-PI is associated with higher rates of FGR but does not improve the prediction of FGR.