title: First-trimester placental ultrasound and maternal serum markers as predictors of small-for-gestational-age infants.
abstract: OBJECTIVE
  The objective of the study was to combine early, direct assessment of the placenta with indirect markers of placental development to identify pregnancies at greatest risk of delivering small-for-gestational age infants (SGA10).
  
  
  METHODS
  We prospectively collected 3-dimensional ultrasound volume sets, uterine artery pulsatility index, and maternal serum of singleton pregnancies at 11-14 weeks. Placental volume (PV), quotient (placental quotient [PQ] = PV/gestational age), mean placental diameter (MPD) and chorionic diameters, and the placental morphology index (PMI = MPD/PQ and adjusts the lateral placental dimensions for quotient) were measured offline. Maternal serum was assayed for placental growth factor and placental protein-13. These variables were evaluated as predictors of SGA10.
  
  
  RESULTS
  Of the 578 pregnancies included in the study, 56 (9.7%) delivered SGA10. SGA10 pregnancies had a significantly smaller PV, PQ, MPD, and mean placental diameter and higher PMI compared with normal pregnancies (P < .001 for each). Each placental measure remained significantly associated with SGA10 after adjusting for confounders and significantly improved the performance of the model using clinical variables alone (P < .04 for each) with adjusted areas under the curve ranging from 0.71 to 0.74. Uterine artery pulsatility index did not remain significantly associated with SGA10 after adjusting for confounders (P = .06). Placental growth factor was significantly lower in SGA10 pregnancies (P = .02) and remained significant in adjusted models but failed to significantly improve the predictive performance of the models as measured by area under the curve (P > .3). Placental protein-13 was not associated with SGA10 (P = .99).
  
  
  CONCLUSIONS
  Direct assessment of placental size and shape with 3-dimensional ultrasound can serve as the foundation upon which to build a multivariable model for the early prediction of SGA.
authors.affiliation: Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Nadav
authors.initials: N
authors.lastname: Schwartz
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.affiliation: Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Rita
authors.initials: R
authors.lastname: Leite
authors.affiliation: Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Parry
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007236:Infant, Small for Gestational Age; D010920:Placenta / Q000000981:diagnostic imaging*; D000072483:Placenta Growth Factor; D011247:Pregnancy / Q000097:blood*; D011257:Pregnancy Proteins / Q000097:blood*; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055988:Uterine Artery / Q000502:physiology
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor
keywords: 3-dimensional ultrasound; fetal growth restriction; placenta; placental growth factor; uterine artery Doppler