Abstract：
To examine the implications of third-trimester small-for-gestational-age (SGA) screening accuracy on severe adverse perinatal outcome (SAPO) and obstetric intervention in a low-risk population. Furthermore, we aimed to explore the additive value of third-trimester sonographic growth-trajectory measurements in predicting SAPO and obstetric intervention.
This was a secondary analysis of a Dutch national multicenter stepped-wedge-cluster randomized trial among 11 820 low-risk pregnant women. Using multilevel multivariable logistic regression analysis, we compared SAPO and obstetric interventions in SGA neonates with and without SGA suspected prenatally (true positives and false negatives) and non-SGA neonates with and without SGA suspected prenatally (false positives and true negatives). In a subsample (n = 7989), we analyzed the associations of abdominal circumference (AC) and estimated fetal weight (EFW) < 10th centile (p10) and third-trimester growth-trajectory indicators AC and EFW crossing > 20 and AC crossing > 50 centiles and the lowest decile of AC growth-velocity Z-scores (ACGV < 10%) with SAPO and obstetric interventions.
SGA infants, i.e. the true-positive and false-negative cases, had an increased risk of SAPO (adjusted odds ratio (aOR), 4.46 (95% CI, 2.28-8.75) and aOR 2.61 (95% CI, 1.74-3.89), respectively), and obstetric intervention (aOR for: induction of labor, 2.99 (95% CI, 2.15-4.17) and 1.38 (95% CI, 1.14-1.66); Cesarean section, 1.82 (95% CI, 1.25-2.66) and 1.27 (95% CI, 1.05-1.54); medically indicated preterm delivery, 2.67 (95% CI, 1.97-3.62) and 1.20 (95% CI, 1.03-1.40)). The false-positive cases did not differ from the true negatives for all outcomes, including obstetric intervention. Of the third-trimester growth-trajectory indicators, only ACGV < 10% was associated moderately with SAPO (aOR, 2.15 (95% CI, 1.17-3.97)), while AC and EFW crossing > 20 and AC crossing > 50 centiles were not. Both EFW < p10 alone (aOR, 1.95 (95% CI, 1.13-3.38)) and EFW < p10 combined with ACGV < 10% (aOR, 4.69 (95% CI, 1.99-11.07)) were associated with SAPO, and they performed equally well in predicting SAPO (area under the receiver-operating-characteristics curve, 0.71 (95% CI, 0.65-0.76) vs 0.72 (95% CI, 0.67-0.77), P = 0.51).
Neonates who had been suspected falsely of being SGA during pregnancy had no higher rates of obstetric intervention than did those without suspicion of SGA prenatally. Our results do not support that third-trimester low fetal growth velocity (ACGV < 10%) may be of additive value for the identification of fetuses at risk of SAPO in populations remaining at low risk throughout pregnancy. AC and EFW crossing > 20 and AC crossing > 50 centiles performed poorly in identifying abnormal fetal growth. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
This was a secondary analysis of a Dutch national multicenter stepped-wedge-cluster randomized trial among 11 820 low-risk pregnant women. Using multilevel multivariable logistic regression analysis, we compared SAPO and obstetric interventions in SGA neonates with and without SGA suspected prenatally (true positives and false negatives) and non-SGA neonates with and without SGA suspected prenatally (false positives and true negatives). In a subsample (n = 7989), we analyzed the associations of abdominal circumference (AC) and estimated fetal weight (EFW) < 10th centile (p10) and third-trimester growth-trajectory indicators AC and EFW crossing > 20 and AC crossing > 50 centiles and the lowest decile of AC growth-velocity Z-scores (ACGV < 10%) with SAPO and obstetric interventions.
SGA infants, i.e. the true-positive and false-negative cases, had an increased risk of SAPO (adjusted odds ratio (aOR), 4.46 (95% CI, 2.28-8.75) and aOR 2.61 (95% CI, 1.74-3.89), respectively), and obstetric intervention (aOR for: induction of labor, 2.99 (95% CI, 2.15-4.17) and 1.38 (95% CI, 1.14-1.66); Cesarean section, 1.82 (95% CI, 1.25-2.66) and 1.27 (95% CI, 1.05-1.54); medically indicated preterm delivery, 2.67 (95% CI, 1.97-3.62) and 1.20 (95% CI, 1.03-1.40)). The false-positive cases did not differ from the true negatives for all outcomes, including obstetric intervention. Of the third-trimester growth-trajectory indicators, only ACGV < 10% was associated moderately with SAPO (aOR, 2.15 (95% CI, 1.17-3.97)), while AC and EFW crossing > 20 and AC crossing > 50 centiles were not. Both EFW < p10 alone (aOR, 1.95 (95% CI, 1.13-3.38)) and EFW < p10 combined with ACGV < 10% (aOR, 4.69 (95% CI, 1.99-11.07)) were associated with SAPO, and they performed equally well in predicting SAPO (area under the receiver-operating-characteristics curve, 0.71 (95% CI, 0.65-0.76) vs 0.72 (95% CI, 0.67-0.77), P = 0.51).
Neonates who had been suspected falsely of being SGA during pregnancy had no higher rates of obstetric intervention than did those without suspicion of SGA prenatally. Our results do not support that third-trimester low fetal growth velocity (ACGV < 10%) may be of additive value for the identification of fetuses at risk of SAPO in populations remaining at low risk throughout pregnancy. AC and EFW crossing > 20 and AC crossing > 50 centiles performed poorly in identifying abnormal fetal growth. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：在低风险人群中，研究孕晚期小于胎龄儿（SGA）筛查准确性对严重不良围产期结局（SAPO）和产科干预的影响。此外，我们旨在探讨妊娠晚期超声检查生长轨迹测量在预测SAPO和产科干预方面的附加价值.
方法：这是一项荷兰国家多中心阶梯式楔形整群随机试验在11820名低风险孕妇中的二次分析。使用多水平多变量逻辑回归分析，我们比较了有和无可疑SGA(真阳性和假阴性)的SGA新生儿和有和无可疑SGA(假阳性和真阴性)的非SGA新生儿的SAPO和产科干预.在子样本(n=7987)中，我们分析了妊娠晚期腹围（AC）和估计胎儿体重<10百分位数（EFW20-和>50百分位数，腹围生长速度Z得分最低分位数（ACGV<10％）。
结果：SGA婴儿，即真阳性和假阴性，SAPO的风险增加（调整后的比值比（aOR）分别为4.46[95％CI，2.28-58.75]和aOR2.61[95％CI，1.74-3.89]），和产科干预措施（引产aOR2.99[95％CI，2.15-4.17]和aOR1.38[95％CI1.14-1.66]；剖宫产aOR1.82[95％CI1.25-2.66]和aOR1.27[95％CI1.05-1.54]；医学指示的早产aOR2.67[95CI1.97-3.62]和aOR1.20[95％CI]1.03）在包括产科干预在内的所有结果中，假阳性与真阴性没有差异。在生长轨迹指标中，只有ACGV<10％与SAPO中度相关（aOR2.15[95CI1.17-3.97]），而交叉百分位数没有。EFW结论：出生体重正常的婴儿，在怀孕期间错误怀疑SGA的产科干预率并不高.我们基于低风险人群的结果并不明确支持妊娠晚期低胎儿生长速度（ACGV<10％）可能对识别有SAPO风险的胎儿具有累加价值。>20和>50的交叉百分位数在识别胎儿生长异常方面表现非常差。本文受版权保护。保留所有权利。
方法：这是一项荷兰国家多中心阶梯式楔形整群随机试验在11820名低风险孕妇中的二次分析。使用多水平多变量逻辑回归分析，我们比较了有和无可疑SGA(真阳性和假阴性)的SGA新生儿和有和无可疑SGA(假阳性和真阴性)的非SGA新生儿的SAPO和产科干预.在子样本(n=7987)中，我们分析了妊娠晚期腹围（AC）和估计胎儿体重<10百分位数（EFW
结果：SGA婴儿，即真阳性和假阴性，SAPO的风险增加（调整后的比值比（aOR）分别为4.46[95％CI，2.28-58.75]和aOR2.61[95％CI，1.74-3.89]），和产科干预措施（引产aOR2.99[95％CI，2.15-4.17]和aOR1.38[95％CI1.14-1.66]；剖宫产aOR1.82[95％CI1.25-2.66]和aOR1.27[95％CI1.05-1.54]；医学指示的早产aOR2.67[95CI1.97-3.62]和aOR1.20[95％CI]1.03）在包括产科干预在内的所有结果中，假阳性与真阴性没有差异。在生长轨迹指标中，只有ACGV<10％与SAPO中度相关（aOR2.15[95CI1.17-3.97]），而交叉百分位数没有。EFW
