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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale

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Published on: August 25, 2014

First and second trimester screening for large for gestational age infants.

Nieves L González González¹, Walter Plasencia, Enrique González Dávila

¹Hospital Universitario de Canarias , Tenerife, Canary Islands , Spain .

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

|May 15, 2013

Summary

This study identifies the best early predictors for fetal growth and large for gestational age (LGA) infants. Combining first and second trimester data significantly improves screening sensitivity for LGA detection.

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Area of Science:

Maternal-fetal medicine
Prenatal diagnostics
Biostatistics

Background:

Accurate prediction of fetal growth and identifying infants large for gestational age (LGA) is crucial for optimizing perinatal outcomes.
Early identification of LGA can help mitigate risks associated with macrosomia, such as birth trauma and neonatal hypoglycemia.

Purpose of the Study:

To develop and evaluate an optimal early prediction model for fetal growth and LGA infants.
To assess the combined utility of clinical, ultrasonographic, and biochemical markers in predicting LGA.

Main Methods:

A cohort of 2097 singleton pregnancies was analyzed in the first trimester for maternal characteristics, PAPP-A, ß-HCG, nuchal translucency (NT), and uterine artery pulsatility index (UtA-PI).
Second trimester assessments included fetal biometry and UtA-PI.
Receiver operating characteristic (ROC) curve analysis was used to evaluate screening performance.

Main Results:

Maternal factors, first-trimester PAPP-A and UtA-PI, and second-trimester biometric variables significantly contributed to birthweight percentile prediction.
A model combining maternal characteristics with first-trimester PAPP-A, β-hCG, NT, and uterine artery PI identified 30.2% of LGA infants at a 10% false-positive rate (FPR).
This combined model achieved a sensitivity of 41.2% (10% FPR) and 56.2% (20% FPR).

Conclusions:

The sensitivity of screening for LGA significantly improves with the integration of second-trimester ultrasound measurements.
Combining first-trimester markers and maternal characteristics with second-trimester ultrasound data offers a more effective approach to identifying LGA infants.