title: First-trimester screening with specific algorithms for early- and late-onset fetal growth restriction.
abstract: OBJECTIVE
  To develop optimal first-trimester algorithms for the prediction of early and late fetal growth restriction (FGR).
  
  
  METHODS
  This was a prospective cohort study of singleton pregnancies undergoing first-trimester screening. FGR was defined as an ultrasound estimated fetal weight < 10(th) percentile plus Doppler abnormalities or a birth weight < 3(rd) percentile. Logistic regression-based predictive models were developed for predicting early and late FGR (cut-off: delivery at 34 weeks). The model included the a-priori risk (maternal characteristics), mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1).
  
  
  RESULTS
  Of the 9150 pregnancies included, 462 (5%) fetuses were growth restricted: 59 (0.6%) early and 403 (4.4%) late. Significant contributions to the prediction of early FGR were provided by black ethnicity, chronic hypertension, previous FGR, MAP, UtA-PI, PlGF and sFlt-1. The model achieved an overall detection rate (DR) of 86.4% for a 10% false-positive rate (area under the receiver-operating characteristics curve (AUC): 0.93 (95% CI, 0.87-0.98)). The DR was 94.7% for FGR with pre-eclampsia (PE) (64% of cases) and 71.4% for FGR without PE (36% of cases). For late FGR, significant contributions were provided by chronic hypertension, autoimmune disease, previous FGR, smoking status, nulliparity, MAP, UtA-PI, PlGF and sFlt-1. The model achieved a DR of 65.8% for a 10% false-positive rate (AUC: 0.76 (95% CI, 0.73-0.80)). The DR was 70.2% for FGR with PE (12% of cases) and 63.5% for FGR without PE (88% of cases).
  
  
  CONCLUSIONS
  The optimal screening algorithm was different for early vs late FGR, supporting the concept that screening for FGR is better performed separately for the two clinical forms. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.|Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors: F
authors: F
authors: Crovetto
authors: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors: S
authors: S
authors: Triunfo
authors: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors: F
authors: F
authors: Crispi
authors: Biochemistry and Molecular Biology Research Centre for Nanomedicine, Hospital Universitari Vall d'Hebron, and Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain.
authors: V
authors: V
authors: Rodriguez-Sureda
authors: Obstetrics and Gynecology Department, Althaia, Network Healthcare Manresa Foundation, Barcelona, Spain.
authors: E
authors: E
authors: Roma
authors: Biochemistry and Molecular Biology Research Centre for Nanomedicine, Hospital Universitari Vall d'Hebron, and Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain.
authors: C
authors: C
authors: Dominguez
authors: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors: E
authors: E
authors: Gratacos
authors: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors: F
authors: F
authors: Figueras
mesh_terms: D000328:Adult; D000465:Algorithms; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis*; D020567:Fetal Weight; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D011257:Pregnancy Proteins
keywords: early fetal growth restriction; fetal growth restriction; first-trimester screening; late fetal growth restriction; placental growth factor; soluble fms-like tyrosine kinase-1