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Changes in uterine artery Doppler velocimetry and circulating angiogenic factors in the first half of pregnancies delivering a small‐for‐gestational‐age neonate
Author(s) -
Triunfo S.,
Crovetto F.,
RodriguezSureda V.,
Scazzocchio E.,
Crispi F.,
Dominguez C.,
Gratacos E.,
Figueras F.
Publication year - 2017
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.15978
Subject(s) - medicine , laser doppler velocimetry , velocimetry , obstetrics , uterine artery , gestational age , gestation , doppler effect , pregnancy , blood flow , cardiology , biology , genetics , physics , astronomy , optics
Objective To assess the relationship between longitudinal changes in placental Doppler indices and maternal circulating angiogenic factors in the first half of pregnancy and delivery of a small‐for‐gestational‐age (SGA) neonate, and ascertain whether longitudinal evaluation of these variables improves the prediction achieved by second‐trimester cross‐sectional evaluation. Methods From a prospective cohort of unselected singleton pregnancies undergoing first‐trimester screening for aneuploidy, 138 were included in this study. Of these, 46 were complicated by SGA (delivering after 34 weeks' gestation with a birth weight < 10 th centile) and 92 were appropriate‐for‐gestational‐age (AGA) pregnancies, which were included as controls (ratio 1:2). First‐to‐second trimester longitudinal changes in uterine artery (UtA) Doppler indices and maternal circulating levels of placental growth factor (PlGF) and soluble fms‐like tyrosine kinase‐1 (sFlt‐1) were analyzed. Results Compared with the AGA group, SGA pregnancies had significantly higher UtA impedance in the first ( Z ‐score: 0.46 vs –0.57; P < 0.001) and second ( Z ‐score: 1.71 vs –0.75; P < 0.001) trimesters. Likewise, the sFlt‐1/PlGF ratio was significantly higher in SGA than in AGA pregnancies in the first (98.0 vs 67.9; P = 0.01) and early second (22.4 vs 8.8; P < 0.001) trimesters. The predictive performance of the longitudinal changes in UtA Doppler indices for SGA was significantly lower than that of second‐trimester cross‐sectional values (area under receiver–operating characteristics curve (AUC), 60.8% vs 84.3%; P = 0.0035). The detection rate of SGA, at a 10% false‐positive rate (FPR), was 17.7% by longitudinal changes in UtA Doppler and 56.2% by second‐trimester cross‐sectional UtA Doppler values. Similarly, the predictive performance of the longitudinal changes in PlGF was significantly lower than that of early second‐trimester cross‐sectional values (AUC, 71.4% vs 76.5%; P = 0.008). The detection rate of SGA at a 10% FPR was 40.6% when screening by longitudinal changes in PlGF and 52.1% when screening by early second‐trimester cross‐sectional values. Conclusions First‐ and second‐trimester UtA Doppler velocimetry and maternal circulating angiogenic markers have clinical utility as a cross‐sectional assessment for the identification of pregnancies at high risk of delivering a SGA neonate, however, they do not improve prediction when their longitudinal changes are used. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.