title: First-trimester prediction of small-for-gestational age neonates incorporating fetal Doppler parameters and maternal characteristics.
abstract: OBJECTIVE
  First-trimester screening for subsequent delivery of a small-for-gestational-age (SGA) infant typically focuses on maternal risk factors and uterine artery (UtA) Doppler. Our aim is to test if incorporation of fetal umbilical artery (UA) and ductus venosus (DV) Doppler improves SGA prediction.
  
  
  METHODS
  Prospective screening study of singletons at 11-14 weeks. Maternal characteristics, serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin are ascertained and UtA Doppler, UA, and DV Doppler studies are performed. These parameters are tested for their ability to predict subsequent delivery of a SGA infant.
  
  
  RESULTS
  Among 2267 enrolled women, 191 (8.4%) deliver an SGA infant. At univariate analysis women with SGA neonates are younger, more frequently African-American (AA), nulliparous, more likely to smoke, have lower PAPP-A and free β-human chorionic gonadotropin levels. They have a higher incidence of UtA Doppler bilateral notching, higher mean UtA Doppler-pulsatility index z-scores (P < .001) and UA pulsatility index z-scores (P = .03), but no significant difference in DV-pulsatility index z-scores or in the incidence of abnormal qualitative UA and DV patterns. Multivariate logistic regression analysis identifies nulliparity and AA ethnicity (P < .001), PAPP-A multiple of the median and bilateral notching (P < .05) as determinants of SGA infant. Predictive sensitivity was low; receiver operating characteristic curve analysis yields areas under the curve of 0.592 (95% confidence interval, 0.548-0.635) for the combination of UtA Doppler and UA pulsatility index z-scores.
  
  
  CONCLUSIONS
  Delivery of a SGA infant is most frequent in nulliparous women of AA ethnicity. Despite the statistical association with UtA Doppler first-trimester SGA prediction is poor and not improved by the incorporation of fetal Doppler.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Viola
authors.initials: V
authors.lastname: Seravalli
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Block-Abraham
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Ozhan M
authors.initials: OM
authors.lastname: Turan
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Doyle
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Jerome N
authors.initials: JN
authors.lastname: Kopelman
authors.affiliation: Department of Obstetrics and Gynecology, Mercy Medical Center, Baltimore, MD.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Atlas
authors.affiliation: Department of Obstetrics and Gynecology, MedStar Harbor Hospital and Franklin Square Hospital Medical Centers, Baltimore, MD.
authors.forename: Chuka B
authors.initials: CB
authors.lastname: Jenkins
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Miriam G
authors.initials: MG
authors.lastname: Blitzer
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Ahmet A
authors.initials: AA
authors.lastname: Baschat
mesh_terms: D000328:Adult; D001741:Black or African American; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D011446:Prospective Studies; D014469:Umbilical Arteries / Q000502:physiology*
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A; C579283:PAPPA protein, human
keywords: Fetal Doppler; first-trimester screening; small for gestational age; umbilical artery; uterine artery