title: First-trimester screening for early and late small-for-gestational-age neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler.
abstract: OBJECTIVE
  To assess the effectiveness of first-trimester screening for early and late small-for-gestational-age (SGA) neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler.
  
  
  METHODS
  This was a prospective study of 4970 women with a singleton pregnancy who underwent routine first-trimester screening between 2009 and 2011. A logistic regression-based predictive model for SGA, defined as birth weight < 10(th) percentile, divided into early- or late-onset based on gestational age at delivery before or after 34 weeks' gestation, was constructed. The model included maternal baseline characteristics: serum levels of pregnancy-associated plasma protein-A and free β-human chorionic gonadotropin at 8-12 weeks and blood pressure and uterine artery Doppler at 11 + 0 to 13 + 6 weeks.
  
  
  RESULTS
  The prevalence of early and late SGA was 0.6% and 7.9%, respectively. Association with pre-eclampsia was 67% and 8%, respectively. At a false-positive rate of 15%, the detection rate for early SGA was 73%; however it differed substantially for cases with and without pre-eclampsia (90% vs 40%). For late SGA, at false-positive rates of 15 and 50%, detection rates were 32% and 70%, respectively, and did not substantially differ between cases with and without pre-eclampsia.
  
  
  CONCLUSIONS
  First-trimester screening predicts early SGA mainly because of its strong association with pre-eclampsia. Although prediction of late SGA was poorer, at a high false-positive rate it might be considered as part of a first-trimester strategy to select women requiring ultrasound assessment in the third trimester.
authors.affiliation: Maternal-Fetal Medicine Department, ICGON, Hospital Clínic, Universitat de Barcelona; Fetal and Perinatal Medicine Research Group, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS); and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain; Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Dipartimento Ostetricia e Ginecologia, Univerisità degli Studi di Milano, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Crovetto
authors.forename: F
authors.initials: F
authors.lastname: Crispi
authors.forename: E
authors.initials: E
authors.lastname: Scazzocchio
authors.forename: I
authors.initials: I
authors.lastname: Mercade
authors.forename: E
authors.initials: E
authors.lastname: Meler
authors.forename: F
authors.initials: F
authors.lastname: Figueras
authors.forename: E
authors.initials: E
authors.lastname: Gratacos
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis*; D007236:Infant, Small for Gestational Age / Q000097:blood / Q000254:growth & development; D011225:Pre-Eclampsia / Q000175:diagnosis*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D011673:Pulsatile Flow; D018617:Ultrasonography, Doppler, Pulsed; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers
keywords: first trimester; pre-eclampsia; screening; small-for-gestational age; uterine artery Doppler