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Evaluation of screening performance of first-trimester competing-risks prediction model for small-for-gestational age
L Nguyen-Hoang1, I Papastefanou2,3, D S Sahota1
1Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
Insights
The Fetal Medicine Foundation (FMF) model accurately predicts small-for-gestational age (SGA) in Asian pregnancies. This first-trimester screening tool combines maternal factors with specific measurements for reliable prediction.
Area of Science:
- Maternal-fetal medicine
- Prenatal diagnostics
- Pregnancy outcomes
Background:
- Small-for-gestational age (SGA) is a significant predictor of adverse perinatal outcomes.
- Accurate first-trimester prediction of SGA can enable timely interventions.
- The Fetal Medicine Foundation (FMF) developed a competing-risks model for SGA prediction.
Purpose of the Study:
- To validate the external applicability of the FMF competing-risks model for SGA prediction in an Asian population.
- To assess the model's performance using maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF).
Main Methods:
- Secondary analysis of a prospective cohort study involving 10,120 women with singleton pregnancies.
- Application of the FMF competing-risks model incorporating maternal factors, MAP, UtA-PI, and PlGF.
- Evaluation of predictive performance for various SGA definitions (e.g., <10th percentile, preterm SGA) using discrimination and calibration metrics.
Main Results:
- The FMF model demonstrated comparable predictive performance to the original study in this Asian cohort.
- The combination of maternal factors with MAP, UtA-PI, and PlGF showed the best prediction for preterm SGA <10th and <5th percentiles (AUCs 0.765 and 0.789).
- Detection rates for preterm SGA <10th, <5th, and <3rd percentiles were 42.2%, 47.3%, and 48.1% at a 10% false-positive rate, with satisfactory calibration.
Conclusions:
- The FMF first-trimester competing-risks model for SGA is externally valid in a large, independent Asian cohort.
- The screening performance is comparable to that reported in the original FMF study.
- This model serves as a valuable tool for first-trimester SGA risk assessment in diverse populations.
Objective:
To examine the external validity of the Fetal Medicine Foundation (FMF) competing-risks model for the prediction of small-for-gestational age (SGA) at 11-14 weeks' gestation in an Asian population.
Methods:
This was a secondary analysis of a multicenter prospective cohort study in 10 120 women with a singleton pregnancy undergoing routine assessment at 11-14 weeks' gestation. We applied the FMF competing-risks model for the first-trimester prediction of SGA, combining maternal characteristics and medical history with measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF) concentration. We calculated risks for different cut-offs of birth-weight percentile (< 10th , < 5th or < 3rd percentile) and gestational age at delivery (< 37 weeks (preterm SGA) or SGA at any gestational age). Predictive performance was examined in terms of discrimination and calibration.
Results:
The predictive performance of the competing-risks model for SGA was similar to that reported in the original FMF study. Specifically, the combination of maternal factors with MAP, UtA-PI and PlGF yielded the best performance for the prediction of preterm SGA with birth weight < 10th percentile (SGA < 10th ) and preterm SGA with birth weight < 5th percentile (SGA < 5th ), with areas under the receiver-operating-characteristics curve (AUCs) of 0.765 (95% CI, 0.720-0.809) and 0.789 (95% CI, 0.736-0.841), respectively. Combining maternal factors with MAP and PlGF yielded the best model for predicting preterm SGA with birth weight < 3rd percentile (SGA < 3rd ) (AUC, 0.797 (95% CI, 0.744-0.850)). After excluding cases with pre-eclampsia, the combination of maternal factors with MAP, UtA-PI and PlGF yielded the best performance for the prediction of preterm SGA < 10th and preterm SGA < 5th , with AUCs of 0.743 (95% CI, 0.691-0.795) and 0.762 (95% CI, 0.700-0.824), respectively. However, the best model for predicting preterm SGA < 3rd without pre-eclampsia was the combination of maternal factors and PlGF (AUC, 0.786 (95% CI, 0.723-0.849)). The FMF competing-risks model including maternal factors, MAP, UtA-PI and PlGF achieved detection rates of 42.2%, 47.3% and 48.1%, at a fixed false-positive rate of 10%, for the prediction of preterm SGA < 10th , preterm SGA < 5th and preterm SGA < 3rd , respectively. The calibration of the model was satisfactory.
Conclusion:
The screening performance of the FMF first-trimester competing-risks model for SGA in a large, independent cohort of Asian women is comparable with that reported in the original FMF study in a mixed European population. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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