First-trimester placental ultrasound and maternal serum markers as predictors of small-for-gestational-age infants

Schwartz, Nadav; Sammel, Mary D.; Leite, Rita; Parry, Samuel

doi:10.1016/j.ajog.2014.02.033

Cited by 58 publications

(85 citation statements)

References 49 publications

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“…The explanation might be that SGA infants in our study represented a very mild form of SGA having mean delivering time at term and mean birth weight only slightly below 10 th percentile. Concentrations of PlGF in normotensive women with SGA infants have been shown to be lower already in the first trimester as compared to controls [50], but in other studies differences in PlGF concentrations have only been present in the second trimester [51] or not at all [52]. …”

Section: Discussionmentioning

confidence: 99%

First trimester serum placental growth factor and hyperglycosylated human chorionic gonadotropin are associated with pre-eclampsia: a case control study

Keikkala

Koskinen

Vuorela

et al. 2016

BMC Pregnancy Childbirth

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BackgroundTo study whether maternal serum hyperglycosylated human chorionic gonadotropin (hCG-h) improves first trimester prediction of pre-eclampsia when combined with placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A) and maternal risk factors.MethodsGestational-age-adjusted concentrations of hCG, hCG-h, PlGF and PAPP-A were analysed in serum samples by time-resolved immunofluorometric assays at 8–13 weeks of gestation. The case–control study included 98 women who developed pre-eclampsia, 25 who developed gestational hypertension, 41 normotensive women with small-for-gestational-age (SGA) infants and 177 controls.ResultsOf 98 women with pre-eclampsia, 24 women developed preterm pre-eclampsia (diagnosis < 37 weeks of gestation) and 13 of them had early-onset pre-eclampsia (diagnosis < 34 weeks of gestation). They had lower concentrations of PlGF, PAPP-A and proportion of hCG-h to hCG (%hCG-h) than controls. In receiver-operating characteristics (ROC) curve analysis, the area under the curve (AUC) for the combination of PlGF, PAPP-A, %hCG-h, nulliparity and mean arterial blood pressure was 0.805 (95% confidence interval, CI, 0.699–0.912) for preterm pre-eclampsia and 0.870 (95% CI 0.750–0.988) for early-onset pre-eclampsia. Without %hCG-h the AUC values were 0.756 (95% CI 0.651–0.861) and 0.810 (95% CI 0.682–0.938) respectively. For prediction of gestational hypertension, the AUC for %hCG-h was 0.708 (95% CI 0.608–0.808), but for other markers the AUC values were not significant. None of the AUC values were significant for the prediction of SGA infants in normotensive women.ConclusionsFirst trimester maternal serum %hCG-h tended to improve prediction of preterm and early-onset pre-eclampsia when combined with PlGF, PAPP-A and maternal risk factors.

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Section: Discussionmentioning

confidence: 99%

First trimester serum placental growth factor and hyperglycosylated human chorionic gonadotropin are associated with pre-eclampsia: a case control study

Keikkala

Koskinen

Vuorela

et al. 2016

BMC Pregnancy Childbirth

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“…This same team even set up specific risk algorithms for screening SGA neonates and preeclampsia by a combination of maternal characteristics and history with biochemical (PAPP-A, PLGF) and biophysical markers (uterine artery pulsatility index, MAP) [22,23]. Similarly, the study conducted by Schwartz et al [24] built a multivariable model of combining indirect markers of placental development (PLGF and placental protein 13) and direct assessment of the placenta at around 11-14 weeks of gestation for the early prediction of SGA. The changes of these biophysical and biochemical markers are thought to be related to placental insufficiency and were gradually utilized widely as predictive tools for SGA pregnancies and preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

Second-Trimester Placental Volume and Vascular Indices in the Prediction of Small-for-Gestational-Age Neonates

Fang¹,

Ou²,

Tsai³

et al. 2014

Fetal Diagn Ther

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Objective: To evaluate the ability of second-trimester placental volume and vascular indices to predict small-for-gestational-age (SGA) birth weight pregnancies. Material and Methods: Women with singleton pregnancies were prospectively evaluated at 17-20 weeks of gestation. Second-trimester placental volume and vascular indices were obtained and calculated using volume organ computer-aided analysis and three-dimensional (3D) power Doppler ultrasound. Participants were followed until delivery and their medical records were reviewed, including maternal age, parity and pregestational body weight and body height, as well as the gestational age, birth weight and gender of the fetus. Results: Of the 163 women with complete follow-up, 20 gave birth to SGA and 143 to appropriate-for-gestational-age (AGA) neonates. The mean second-trimester placental volume was significantly lower in the SGA than in the AGA group (170.6 ± 49.8 vs. 213.5 ± 75.8 cm³, p = 0.015). None of the vascular indices, including the vascularization index, flow index and vascularization flow index, differed significantly between the two groups. We also found that the optimum cutoff for placental volume at a gestational age of 17-18 weeks was 189.7 cm³. Discussion: Second-trimester placental volume was positively correlated with neonatal birth weight. Second-trimester placental volume measured on 3D ultrasound may be predictive of SGA neonates.

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“…This model uses the linear measurements of placental width, height and thickness to calculate the volume of an elliptical cylinder and has been correlated to placental weights (18). EPV measurements by 2D and 3D ultrasound have been used in several studies across all gestations and have been found to correlate significantly with gestational weight at delivery (19–21). …”

Section: Methodsmentioning

confidence: 99%

“…A power calculation was performed and we were adequately powered (power > 90%) to detect a mean difference in EPV of anywhere between 1 and 15 cm 3 with our sample size. We selected the EPV between 1 and 15 cm 3 since fetal growth restriction has been associated with fertility treatments and an EPV of 15 cm 3 is a predictor of fetal growth restriction based on a study by Schwartz, et al (19)…”

Section: Methodsmentioning

confidence: 99%

Mode of conception does not appear to affect placental volume in the first trimester

Churchill

Wang

Goldstein

et al. 2017

Fertility and Sterility

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Objective To study whether infertility treatments, including IVF and non-IVF fertility treatments (NIFT), are associated with diseases of placental insufficiency in early gestation. First trimester placental volumes by ultrasound and chorionic villi weight during sampling (CVS) were performed to detect differences between pregnancies conceived spontaneously versus with fertility treatments. Design Retrospective cohort Setting Academic tertiary center Patients Women with singleton pregnancies undergoing CVS and first trimester ultrasound from 4–2007 to 11–2015. Interventions Estimated placental volume (EPV) was calculated from ultrasound images using a validated computation and CVS estimated tissue weight was performed using a validated visual analog scale. Main Outcomes Measured Adjusted linear regression was used to compare EPV and CVS weight based on mode of conception. Results 1977 spontaneous, 334 conceived with fertility treatments (133 NIFT, and 201 IVF) were included. Significant differences in maternal age, gravidity, hypertension and smoking status were identified. EPV and CVS weight were correlated with maternal age, gestational age, and maternal hypertension. Adjusted linear regression showed no difference in EPV in pregnancies conceived with fertility treatments versus spontaneously. CVS weight was significantly lower in the IVF conceptions in unadjusted univariate analyses. However, following adjusted regression, this was no longer significant. Conclusions Mode of conception does not appear to affect first trimester placental size. As differences in maternal age, hypertension and smoking status differ among the groups and are correlated to placental size, it may be the underlying patient population leading to abnormal placentation and insufficiency, not the fertility treatments utilized.

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First-trimester placental ultrasound and maternal serum markers as predictors of small-for-gestational-age infants

Cited by 58 publications

References 49 publications

First trimester serum placental growth factor and hyperglycosylated human chorionic gonadotropin are associated with pre-eclampsia: a case control study

First trimester serum placental growth factor and hyperglycosylated human chorionic gonadotropin are associated with pre-eclampsia: a case control study

Second-Trimester Placental Volume and Vascular Indices in the Prediction of Small-for-Gestational-Age Neonates

Mode of conception does not appear to affect placental volume in the first trimester

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