Navigating Uncertain Waters: First-Trimester Screening's Role in Identifying Neonatal Complications

Area of Science:

• Perinatal medicine
• Biochemical markers in pregnancy
• Neonatal outcomes

Background:

• Current assessment of neonatal outcomes relies heavily on maternal medical history.
• A need exists for universal biomarkers to identify high-risk pregnancies and infants requiring Neonatal Intensive Care Unit (NICU) admission.
• This study investigates the utility of first-trimester screening markers for predicting neonatal condition.

Purpose of the Study:

• To evaluate if biochemical and ultrasonographical markers from first-trimester screening can predict adverse neonatal outcomes.
• To assess the correlation between PAPP-A and fbHCG levels and neonatal Apgar scores, umbilical cord pH, and NICU admission rates.

Main Methods:

• Analysis of data from 1164 patients undergoing first-trimester screening (January 2019-December 2021).
• Included patient history, ultrasound, and biochemical tests for PAPP-A and fbHCG.
• Correlated screening results with neonatal Apgar scores, umbilical blood pH, and NICU admission.

Main Results:

• Lower first-trimester PAPP-A concentrations (MoM 0.93 vs. 1.027, p=0.032) were associated with Apgar scores < 8.
• Higher venous duct pulsatility index observed in neonates with Apgar scores < 8.
• Lower PAPP-A (0.69 vs. 1.01 MoM, p=0.04) and fbHCG (0.93 vs. 1.11 MoM, p=0.03) linked to lower umbilical pH and NICU admission, respectively.
• Predictive ability for dichotomous outcomes was limited (AUC < 0.7).

Conclusions:

• Low first-trimester PAPP-A and fbHCG levels may correlate with poorer neonatal clinical and biochemical conditions.
• The predictive capability of these markers for adverse neonatal outcomes is weak.
• Further research is needed to determine their role in stratifying high-risk pregnancies for neonatological complications.