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Type: Journal article
Title: Prediction of small for gestational age infants in healthy nulliparous women using clinical and ultrasound risk factors combined with early pregnancy biomarkers
Author: McCowan, L.M.E.
Thompson, J.M.D.
Taylor, R.S.
Baker, P.N.
North, R.A.
Poston, L.
Roberts, C.T.
Simpson, N.A.B.
Walker, J.J.
Myers, J.
Kenny, L.C.
Healy, D.
Briley, A.
Murphy, N.
Snapes, E.
Chan, E.
Black, M.
Citation: PLoS One, 2017; 12(1):0169311-1-0169311-15
Publisher: Public Library of Science
Issue Date: 2017
ISSN: 1932-6203
Statement of
Lesley M. E. McCowan, John M. D. Thompson, Rennae S. Taylor, Philip N. Baker, Robyn A. North, Lucilla Poston, Claire T. Roberts, Nigel A. B. Simpson, James J. Walker, Jenny Myers, Louise C. Kenny
Abstract: OBJECTIVE: Most small for gestational age pregnancies are unrecognised before birth, resulting in substantial avoidable perinatal mortality and morbidity. Our objective was to develop multivariable prediction models for small for gestational age combining clinical risk factors and biomarkers at 15±1 weeks' with ultrasound parameters at 20±1 weeks' gestation. METHODS: Data from 5606 participants in the Screening for Pregnancy Endpoints (SCOPE) cohort study were divided into Training (n = 3735) and Validation datasets (n = 1871). The primary outcomes were All-SGA (small for gestational age with birthweight <10th customised centile), Normotensive-SGA (small for gestational age with a normotensive mother) and Hypertensive-SGA (small for gestational age with an hypertensive mother). The comparison group comprised women without the respective small for gestational age phenotype. Multivariable analysis was performed using stepwise logistic regression beginning with clinical variables, and subsequent additions of biomarker and then ultrasound (biometry and Doppler) variables. Model performance was assessed in Training and Validation datasets by calculating area under the curve. RESULTS: 633 (11.2%) infants were All-SGA, 465(8.2%) Normotensive-SGA and 168 (3%) Hypertensive-SGA. Area under the curve (95% Confidence Intervals) for All-SGA using 15±1 weeks' clinical variables, 15±1 weeks' clinical+ biomarker variables and clinical + biomarkers + biometry /Doppler at 20±1 weeks' were: 0.63 (0.59-0.67), 0.64 (0.60-0.68) and 0.69 (0.66-0.73) respectively in the Validation dataset; Normotensive-SGA results were similar: 0.61 (0.57-0.66), 0.61 (0.56-0.66) and 0.68 (0.64-0.73) with small increases in performance in the Training datasets. Area under the curve (95% Confidence Intervals) for Hypertensive-SGA were: 0.76 (0.70-0.82), 0.80 (0.75-0.86) and 0.84 (0.78-0.89) with minimal change in the Training datasets. CONCLUSION: Models for prediction of small for gestational age, which combine biomarkers, clinical and ultrasound data from a cohort of low-risk nulliparous women achieved modest performance. Incorporation of biomarkers into the models resulted in no improvement in performance of prediction of All-SGA and Normotensive-SGA but a small improvement in prediction of Hypertensive-SGA. Our models currently have insufficient reliability for application in clinical practice however, they have potential utility in two-staged screening tests which include third trimester biomarkers and or fetal biometry.
Keywords: SCOPE consortium; Humans; Ultrasonography, Prenatal; Prognosis; Pregnancy Outcome; Risk Factors; Parity; Gestational Age; Pregnancy; Pregnancy Trimester, Third; Infant, Small for Gestational Age; Female; Biomarkers
Rights: Copyright: © 2017 McCowan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
RMID: 0030061625
DOI: 10.1371/journal.pone.0169311
Grant ID:
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