Maternal first trimester SIMPLE nutritional score, early markers of placental function and pregnancy outcome: a...

To evaluate associations between the first trimester SIMPLE nutritional score, early placental markers, and pregnancy outcome.

This is a longitudinal prospective multicenter observational cohort study recruiting healthy women with no comorbidities and singleton viable pregnancies undergoing first trimester prenatal screening. The SIMPLE nutritional score, biochemical (pregnancy-associated plasma protein A (PAPP-a), free ß-human chorionic gonadotropin (β-HCG)) and ultrasound (placental volume, uterine artery Doppler velocimetry) markers of placental function were collected at enrollment. Birth outcomes were collected at delivery.

Multivariate generalized linear and logistic regression models were performed to investigate associations between SIMPLE score subgroups (<6 versus ≥6) and items, placental markers, and pregnancy outcomes.

Out of 2363 women enrolled, 325 were classified at high nutritional risk based on a first trimester SIMPLE score lower than 6. Multi-adjusted models showed that the SIMPLE score subgroup was significantly associated with first trimester PAPP-a concentrations (SIMPLE score ≥6 versus <6: β = 0.047 (95% CI 0.004;0.089), p < 0.05), as well as with the emergency cesarean section rates (SIMPLE score ≥6 versus <6: aOR = 0.73 (95% CI -1.38;-0.07), p < 0.05). The single item related to the first trimester hemoglobin concentrations higher than 110 g/L was significantly associated with early placental markers, birth (β = -116.2 (95% CI -213.6;18.7), p < 0.05) and placental weights (β = -28.2 (95% CI -50.4;6.0), p < 0.05) in multi-adjusted models.

The observed associations support the introduction of the SIMPLE score in clinical practice as a useful tool for predicting early placental development and pregnancy outcome.