Second-trimester contingent screening for small-for-gestational-age neonate.

Area of Science:

• Maternal-fetal medicine
• Prenatal diagnostics
• Reproductive endocrinology

Background:

• Accurate prediction of small-for-gestational-age (SGA) neonates is crucial for optimizing perinatal outcomes.
• Second-trimester screening strategies aim to identify pregnancies at risk for SGA.

Purpose of the Study:

• To evaluate the additive value of second-trimester placental growth factor (PlGF) in predicting SGA neonates.
• To assess the efficacy of contingent screening strategies incorporating PlGF for SGA prediction.

Main Methods:

• Prospective observational study involving 40,241 singleton pregnancies.
• Utilized a competing-risks model for SGA prediction.
• Compared prediction models including maternal risk factors, estimated fetal weight (EFW), uterine artery pulsatility index (UtA-PI), and PlGF.

Main Results:

• The combination of maternal risk factors, EFW, UtA-PI, and PlGF significantly improved SGA prediction compared to maternal risk factors alone.
• Incorporating PlGF to maternal risk factors and EFW enhanced SGA prediction.
• Contingent screening strategies allowed for similar detection rates with reduced testing by reserving UtA-PI and PlGF measurements for specific population subsets.

Conclusions:

• The combination of maternal risk factors, EFW, UtA-PI, and PlGF offers effective second-trimester prediction of SGA.
• Serum PlGF is valuable for predicting severe SGA (<3rd percentile) when combined with maternal and biophysical markers.
• Contingent screening strategies can achieve comparable detection rates and false-positive rates, optimizing resource allocation.