Combined first-trimester screening for preterm small-for-gestational-age infants: Australian multicenter clinical feasibility study.

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology Pub Date : 2025-01-18 DOI:10.1002/uog.29174

R J Selvaratnam, D L Rolnik, M Setterfield, E M Wallace, J A Hyett, F Da Silva Costa, A C Mclennan

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引用次数: 0

Abstract

Objective: To assess the performance of the Fetal Medicine Foundation (FMF) first-trimester competing-risks screening model for small-for-gestational-age (SGA) fetuses requiring delivery at < 37 weeks' gestation, in a large cohort of women receiving maternity care in Australia.

Methods: This was a retrospective analysis of prospectively collected data from a cohort of women attending one of two private multicenter fetal medicine practices for first-trimester screening for preterm pre-eclampsia (PE), defined as PE requiring delivery before 37 weeks' gestation. Risk for preterm SGA, defined as SGA requiring delivery before 37 weeks, was calculated but was not disclosed to the patient or referring physician. Screening data were matched to obstetric outcomes. The primary outcome was the efficacy of the FMF screening model in assessing the risk of preterm SGA. The potential effect on identifying other adverse pregnancy outcomes was also assessed.

Results: During the study period, 22 841 women with a singleton pregnancy underwent combined first-trimester screening for preterm PE. These data were compared with those of 301 721 women in the state of Victoria with a singleton pregnancy who did not undergo screening during the study period. Calculation of the risk for preterm SGA identified 3030 (13.3%) pregnancies as high risk. The sensitivity of the model was 48.6% (95% CI, 41.0-56.2%), specificity was 87.0% (95% CI, 86.6-87.5%) and positive and negative predictive values were 2.9% (95% CI, 2.7-3.1%) and 99.5% (95% CI, 99.4-99.6%) respectively. Pregnancies at high risk for preterm SGA were also more likely to have preterm PE (risk ratio (RR), 2.28 (95% CI, 1.72-3.03)) and preterm birth (RR, 1.46 (95% CI, 1.32-1.63)), compared with unscreened pregnancies. Pregnancies at low risk for preterm SGA were less likely to result in a stillbirth (RR, 0.64 (95% CI, 0.47-0.86)) compared with unscreened pregnancies.

Conclusion: Combined first-trimester screening for preterm SGA shows moderate screening efficacy and therefore could help to inform pregnancy management and improve antenatal resource allocation. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

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联合早期筛查早产小于胎龄儿：澳大利亚多中心临床可行性研究。

目的：评估胎儿医学基金会（FMF）早期妊娠竞争风险筛查模型在需要分娩的小胎龄（SGA）胎儿中的表现：这是一项回顾性分析，前瞻性收集了一组妇女的数据，这些妇女参加了两个私人多中心胎儿医学实践之一，用于早期筛查早产先兆子痫（PE），定义为需要在妊娠37周前分娩的PE。早产SGA的风险（定义为需要在37周前分娩的SGA）被计算，但未向患者或转诊医生披露。筛查数据与产科结果相匹配。主要结果是FMF筛选模型在评估早产SGA风险方面的有效性。对其他不良妊娠结局的潜在影响也进行了评估。结果：在研究期间，22 841名单胎妊娠妇女接受了联合妊娠早期PE筛查。这些数据与维多利亚州301 721名在研究期间没有接受筛查的单胎妊娠妇女的数据进行了比较。通过计算SGA早产风险，3030例（13.3%）妊娠属于高危妊娠。该模型的敏感性为48.6% (95% CI, 41.0 ~ 56.2%)，特异性为87.0% (95% CI, 86.6 ~ 87.5%)，阳性预测值和阴性预测值分别为2.9% （95% CI, 2.7 ~ 3.1%）和99.5% （95% CI, 99.4 ~ 99.6%）。与未筛查的妊娠相比，早产SGA高风险妊娠也更容易发生早产PE（风险比（RR）， 2.28 (95% CI, 1.72-3.03)）和早产（RR, 1.46 (95% CI, 1.32-1.63)）。与未筛查的妊娠相比，早产SGA风险低的妊娠不太可能导致死产（RR, 0.64 (95% CI, 0.47-0.86)）。结论：早期联合筛查对早产儿SGA的筛查效果中等，有助于妊娠管理和改善产前资源配置。©2025国际妇产科超声学会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ultrasound in Obstetrics & Gynecology 医学-妇产科学

CiteScore

12.30

自引率

14.10%

发文量

891

审稿时长

1 months

期刊介绍： Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.