Abstract
Objective
To estimate the role of first-trimester uterine artery pulsatility index (UtA-PI)
for the prediction of small-for-gestational age (SGA).
Methods
We conducted a prospective cohort study of nulliparous women with singleton pregnancy
(Great Obstetrical Syndromes study). UtA-PI was performed at 11 + 0 to 13 + 6 weeks
and was reported in multiple of median (MoM). SGA was defined as birth weight below
the 10th percentile and stratified as term or preterm SGA. Receiver operating characteristic
curves analyses with their area under the curve (AUC) were used to estimate the predictive
values of UtA-PI, alone and UtA-PI combined with maternal characteristics. We computed
the detection rate and false-positive rate (FPR) of the SOGC SGA screening guidelines
in our population.
Results
Of 4610 participants, SGA was identified in 486 pregnancies (10.3%), including 15
(0.3%) associated with preterm delivery. Compared with unaffected pregnancies, the
mean log UtA-PI was significantly higher in term SGA and preterm SGA. The difference
between preterm SGA and unaffected pregnancies remains significant after exclusion
of SGA without preeclampsia. First-trimester UtA-PI was more predictive of preterm
(AUC: 0.89) than term (AUC: 0.60) SGA (P < 0.01). Combined with maternal characteristics, UtA-PI could have predicted 64%
of preterm and 20% of term SGA (10% FPR). The SOGC guidelines criteria for early screening
of SGA had a detection rate of 21% for a FPR of 21%.
Conclusions
First-trimester UtA-PI can be used to predict SGA, but mainly preterm SGA. The current
SOGC guidelines criteria for SGA screening are not efficient in nulliparous women.
Résumé
Objectif
Évaluer le rôle de l'indice de pulsatilité des artères utérines (IPAU) au premier
trimestre pour prédire les bébés petits pour l'âge gestationnel (PAG).
Méthodologie
Nous avons mené une étude de cohorte prospective auprès de femmes nullipares enceintes
d'un seul fœtus (étude sur les grands syndromes obstétricaux). L'IPAU a été mesuré
entre 11+0 et 13+6 semaines de grossesse et a été exprimé en multiples de la médiane
(MoM). La notion de PAG était définie comme étant un poids à la naissance sous le
10e centile, et les cas ont été stratifiés selon que les bébés étaient nés à terme ou
prématurément. L'analyse des courbes caractéristiques de la performance d'un test,
notamment la surface sous la courbe (SSC), a servi à estimer les valeurs prédictives
de l'IPAU, seul et combiné aux caractéristiques maternelles. Nous avons calculé dans
notre population les taux de détection et de faux positifs associés aux recommandations
de la SOGC pour le dépistage des bébés PAG.
Résultats
Parmi les 4 610 participantes, nous avons recensé 486 cas (10,3 %) de bébés PAG, dont
15 (0,3 %) étaient associés à la prématurité. La moyenne logarithmique de l'IPAU était
significativement plus élevée chez les cas de bébés PAG (nés à terme et avant terme)
que chez les grossesses non touchées. La différence entre les bébés PAG prématurés
et les bébés des grossesses non touchées était significative après l'exclusion des
cas de PAG où la prééclampsie n'était pas un facteur. L'IPAU au premier trimestre
était un meilleur facteur de prédiction de bébés PAG nés avant terme (SSC : 0,89)
que de bébés PAG nés à terme (SSC : 0,60) [P < 0,01]. Combiné aux caractéristiques maternelles, l'IPAU aurait permis de prédire
64 % des cas de PAG avant terme et 20 % des cas à terme (taux de faux positifs : 10 %).
Les recommandations de la SOGC pour le dépistage précoce des bébés PAG avaient un
taux de détection de 21 % et un taux de faux positifs de 21 %.
Conclusions
L'IPAU au premier trimestre peut servir à prédire les bébés PAG, mais surtout chez
les bébés prématurés. Les recommandations actuelles de la SOGC ne sont pas efficaces
chez les femmes nullipares.
Key Words
Abbreviations:
ART (assisted reproductive technology), DR (detection rate), FPR (false-positive rate), MoM (multiple of median), UtA-PI (uterine artery pulsatility index)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 10, 2018
Accepted:
February 2,
2018
Received:
December 1,
2017
Footnotes
Competing interests: The authors declare that they have no competing interests.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
