title: Maternal demographics and hemodynamics for the prediction of fetal growth restriction at booking, in pregnancies at high risk for placental insufficiency.
abstract: BACKGROUND
  Fetal growth restriction (FGR) is associated with poor perinatal outcomes. Screening and prevention tools for FGR, such as uterine artery Doppler imaging and aspirin, underperform in high-risk groups, compared with general antenatal populations. There is a paucity of sensitive screening tests for the early prediction of FGR in high-risk pregnancies.
  
  
  METHODS
  This was a prospective observational study based in a dedicated antenatal hypertension clinic at a tertiary UK hospital. We assessed maternal demographic and central hemodynamic variables as predictors for FGR in a group of women at high risk for placental insufficiency due to chronic hypertension (n = 55) or a history of hypertension in a previous pregnancy (n = 71). Outcome variables were birthweight z-score as well as development of FGR (defined as birthweight below the 5th or 3rd centile). Maternal hemodynamics were assessed using a noninvasive transthoracic bioreactance monitor (Cheetah NICOM).
  
  
  RESULTS
  The mean gestation at presentation was 13.6 (range: 8.5-19.5) weeks. Sixteen women delivered babies below the 5th centile. Ten of these were below the 3rd centile. Independent predictors of birthweight z-score were body surface area, peripheral vascular resistance and white ethnicity (R(2) = 0.26, p < 0.0001). Independent predictors of FGR were maternal height and cardiac output. The area under the receiver operator characteristic curve for prediction of FGR was 0.915 (95% CI 0.859-0.972) and 0.9079 (95% CI 0.823-0.990) for FGR below the 5th and 3rd centiles, respectively.
  
  
  CONCLUSIONS
  In women with chronic hypertension or a history of hypertension in a previous pregnancy, maternal size and cardiac output at booking provide a sensitive screening tool for FGR.
authors.affiliation: Division of Women's Health, King's College Hospital, Antenatal Hypertension Clinic, London, UK.
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0002-5207-5560
authors.initials: D
authors.lastname: Stott
authors.affiliation: Division of Women's Health, King's College Hospital, Antenatal Hypertension Clinic, London, UK.
authors.forename: Mareike
authors.identifier: http://orcid.org/0000-0003-4771-3748
authors.initials: M
authors.lastname: Bolten
authors.affiliation: Division of Women's Health, King's College Hospital, Antenatal Hypertension Clinic, London, UK.
authors.forename: Mona
authors.identifier: http://orcid.org/0000-0002-2063-3644
authors.initials: M
authors.lastname: Salman
authors.affiliation: Division of Women's Health, King's College Hospital, Antenatal Hypertension Clinic, London, UK.
authors.forename: Daniela
authors.identifier: http://orcid.org/0000-0002-6065-110X
authors.initials: D
authors.lastname: Paraschiv
authors.affiliation: Division of Women's Health, King's College Hospital, Antenatal Hypertension Clinic, London, UK.
authors.forename: Katherine
authors.identifier: http://orcid.org/0000-0001-7149-2899
authors.initials: K
authors.lastname: Clark
authors.affiliation: Division of Women's Health, King's College Hospital, Antenatal Hypertension Clinic, London, UK.|Division of Women's Health, King's College Hospital, Harris Birthright Research Centre for Fetal Medicine, London, UK.
authors.forename: Nikos A
authors.identifier: http://orcid.org/0000-0002-7992-6038
authors.initials: NA
authors.lastname: Kametas
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001724:Birth Weight; D001827:Body Height; D001830:Body Surface Area; D002302:Cardiac Output; D002908:Chronic Disease; D003710:Demography; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology / Q000503:physiopathology*; D046110:Hypertension, Pregnancy-Induced / Q000503:physiopathology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011295:Prenatal Care; D011446:Prospective Studies; D012372:ROC Curve; D014655:Vascular Resistance; D044465:White People
keywords: Fetal growth restriction; bioreactance; cardiac output; hypertension; peripheral vascular resistance; pregnancy