A prediction model for short-term neonatal outcomes in severe early-onset fetal growth restriction

Severe early-onset fetal growth restriction (FGR) predisposes to fetal death, neonatal death, neonatal morbidity and neurodisability. The use of placental biomarkers has been proposed for risk stratification in pre-eclampsia, but they could be equally useful in fetal growth restriction in aiding man...

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Published in:European journal of obstetrics & gynecology and reproductive biology 2019-10, Vol.241, p.109-118
Main Authors: Sharp, Andrew, Jackson, Richard, Cornforth, Christine, Harrold, Jane, Turner, Mark A., Kenny, Louise, Baker, Philip N., Johnstone, Edward D., Khalil, Asma, von Dadelszen, Peter, Papageorghiou, Aris T., Alfirevic, Zarko
Format: Article
Language:English
Subjects:
Adult
Biomarkers - blood
Birth Weight
Female
Fetal growth restriction
Fetal Growth Retardation
Humans
Infant, Newborn
Models, Statistical
Pregnancy
Pregnancy Outcome - epidemiology
sFlt-1:PlGF ratio
Stillbirth
Ultrasonography, Prenatal
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Summary:Severe early-onset fetal growth restriction (FGR) predisposes to fetal death, neonatal death, neonatal morbidity and neurodisability. The use of placental biomarkers has been proposed for risk stratification in pre-eclampsia, but they could be equally useful in fetal growth restriction in aiding management. To determine the efficacy of angiogenic biomarkers at predicting adverse pregnancy outcome in severe early-onset fetal growth restriction. This is a secondary analysis of the multicentre, placebo-controlled STRIDER UK randomised controlled trial of singleton pregnancies with severe early-onset fetal growth restriction. Women with FGR pregnancies between 22+0 and 29+6 weeks of gestation were randomly assigned to receive either sildenafil 25 mg three times daily or placebo until 32+0 weeks’ gestation or delivery. We developed prediction models based upon maternal demographics (age, parity, blood pressure, preeclampsia, gestational hypertension), fetal biometric (estimated fetal weight) and Doppler measurements (Middle Cerebral Artery (MCA), Umbilical Artery (UA)) and maternal angiogenic biomarkers [placental growth factor (PlGF), soluble endoglin (sEng), soluble fms-like tyrosine kinase 1 (sFlt-1) and sFlt-1:PlGF ratio) using both univariate and multivariate analysis. A complete data set was available for 105 of 135 randomised women. Multivariate regression analysis identified estimated fetal weight (EFW) and sFlt-1:PlGF as independent predictors of livebirth (EFW OR: 1.01 (1.008, 1.021); p 
ISSN:0301-2115
1872-7654
DOI:10.1016/j.ejogrb.2019.08.007