Which ultrasound or biochemical markers are independent predictors of small‐for‐gestational age?
Abstract
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 β‐human chorionic gonadotropin (β‐hCG) were measured. Fetal biparietal diameter, femur length, abdominal and head 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 β‐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 © 2009 ISUOG. Published by John Wiley & Sons, Ltd.
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First trimester placental volume has long been known to correlate with birth weight at term.
“First trimester placental volume (PlVol) has long been known to correlate with birth weight at term (7-9), and it was suggested as early as 1981 that PlVol measured with B-mode ultrasound could be used to screen for growth restriction (10).”
From Fully automated, real-time 3D ultrasound segmentation to estimate first trimester placental volume using deep learning (2018) · cites this paper as [8]
PlVol has been demonstrated to be independent of other biomarkers for SGA, such as PAPP-A and nuchal translucency.
“As PlVol has also been demonstrated to be independent of other biomarkers for SGA, such as pregnancy-associated plasma protein A (PAPP-A) (8, 11) and nuchal translucency (11), a recent systematic review concluded that it could be successfully integrated into a future multivariable screening method for SGA (12) analogous to the 'combined test' currently used to screen for fetal aneuploidy.”
From Fully automated, real-time 3D ultrasound segmentation to estimate first trimester placental volume using deep learning (2018) · cites this paper as [8]
First trimester placental volume and vascularity are linked to adverse pregnancy outcomes including FGR and pre-eclampsia.
“Both the volume and vascularity of the first trimester placenta has been demonstrated to be linked to adverse pregnancy outcomes including FGR and pre-eclampsia.”
From Volume and vascularity: Using ultrasound to unlock the secrets of the first trimester placenta (2019) · cites this paper as [27]
Low placental volume (PlaV) at 11-13 weeks is associated with SGA/FGR and pre-eclampsia, independent of PAPP-A and nuchal translucency measurements.
“It has now been shown that low placental volume (PlaV) at 11–13 weeks is associated with SGA/FGR [23, 26–28] and pre-eclampsia [28, 29], and that this is independent of PAPP-A and nuchal translucency (NT) measurements [27].”
From Volume and vascularity: Using ultrasound to unlock the secrets of the first trimester placenta (2019) · cites this paper as [27]
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- Authors
- Law, L. W., Leung, T. Y., Sahota, D. S., Chan, L. W., Fung, T. Y., & Lau, T. K.
- Affiliations
- Chinese University of Hong Kong (HK)
- Corresponding author
- Law, L. W.
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2009-08-10
- Volume
- 34
- Issue
- 3
- Pages
- 283-287
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- OpenAlex
- W2033643158
- Cited by
- 59
- References
- 22
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 3 · 2015: 8 · 2014: 5 · 2013: 4 · 2012: 6
- FWCI
- 8.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Keywords
- small for gestational age, fetal growth prediction, placental volume, uterine artery pulsatility index, crown-rump length, first-trimester markers, PAPP-A, free beta-hCG, birth weight, singleton pregnancy
- MeSH terms
- Birth Weight, Female, Gestational Age, Humans, Infant, Newborn, Infant, Small for Gestational Age, Longitudinal Studies, Organ Size, Placenta, Pregnancy, Pregnancy Trimester, First, Pregnancy Trimester, Second, Pregnancy-Associated Plasma Protein-A, Prospective Studies, Biomarkers, Ultrasonography, Prenatal, Crown-Rump Length, Chorionic Gonadotropin, beta Subunit, Human, Fetal Development
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