Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women

Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. Objective We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. Study Design Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days’ and 22 weeks 6 days’ gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. Results Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P <.0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. Conclusion In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.

Original languageEnglish (US)
Pages (from-to)594.e1-594.e10
JournalAmerican journal of obstetrics and gynecology
Volume217
Issue number5
DOIs
StatePublished - Nov 1 2017

Fingerprint

Uterine Artery
Second Pregnancy Trimester
Growth
Pregnancy
ROC Curve
Parturition
First Pregnancy Trimester
Pregnancy Outcome
Placenta
Compliance
Body Mass Index
Cohort Studies
Smoking
Mothers
Newborn Infant
Prospective Studies
Hypertension

Keywords

  • Doppler ultrasound
  • gestational hypertension
  • small for gestational age
  • spontaneous preterm birth
  • uterine artery

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be. / Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women. In: American journal of obstetrics and gynecology. 2017 ; Vol. 217, No. 5. pp. 594.e1-594.e10.
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title = "Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women",
abstract = "Background Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. Objective We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. Study Design Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days’ and 22 weeks 6 days’ gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. Results Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5{\%}) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P <.0001 for each), but the positive predictive values for these cutoffs were all <15{\%} and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. Conclusion In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.",
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author = "{Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be} and Samuel Parry and Anthony Sciscione and Haas, {David M.} and Grobman, {William A} and Iams, {Jay D.} and Mercer, {Brian M.} and Silver, {Robert M.} and Simhan, {Hyagriv N.} and Wapner, {Ronald J.} and Wing, {Deborah A.} and Elovitz, {Michal A.} and Schubert, {Frank P.} and Peaceman, {Alan M} and Esplin, {M. Sean} and Steve Caritis and Nageotte, {Michael P.} and Carper, {Benjamin A.} and Saade, {George R.} and Reddy, {Uma M.} and Parker, {Corette B.}",
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Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women. / Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be.

In: American journal of obstetrics and gynecology, Vol. 217, No. 5, 01.11.2017, p. 594.e1-594.e10.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women

AU - Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be

AU - Parry, Samuel

AU - Sciscione, Anthony

AU - Haas, David M.

AU - Grobman, William A

AU - Iams, Jay D.

AU - Mercer, Brian M.

AU - Silver, Robert M.

AU - Simhan, Hyagriv N.

AU - Wapner, Ronald J.

AU - Wing, Deborah A.

AU - Elovitz, Michal A.

AU - Schubert, Frank P.

AU - Peaceman, Alan M

AU - Esplin, M. Sean

AU - Caritis, Steve

AU - Nageotte, Michael P.

AU - Carper, Benjamin A.

AU - Saade, George R.

AU - Reddy, Uma M.

AU - Parker, Corette B.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. Objective We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. Study Design Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days’ and 22 weeks 6 days’ gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. Results Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P <.0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. Conclusion In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.

AB - Background Trophoblastic invasion of the uterine spiral arteries substantially increases compliance to accommodate increased blood flow to the placenta. Failure of this process impedes uterine artery blood flow, and this may be detected by uterine artery Doppler flow studies. However, the clinical utility of uterine artery Doppler flow studies in the prediction of adverse pregnancy outcomes in a general population remains largely unknown. Objective We sought to determine the utility of early second-trimester uterine artery Doppler studies as a predictor of small-for-gestational-age neonates. Study Design Nulliparous women with a viable singleton pregnancy were recruited during their first trimester into an observational prospective cohort study at 8 institutions across the United States. Participants were seen at 3 study visits during pregnancy and again at delivery. Three indices of uterine artery Doppler flow (resistance index, pulsatility index, and diastolic notching) were measured in the right and left uterine arteries between 16 weeks 0 days’ and 22 weeks 6 days’ gestation. Test characteristics for varying thresholds in the prediction of small for gestational age (defined as birthweight <5th percentile for gestational age [Alexander growth curve]) were evaluated. Results Uterine artery Doppler indices, birthweight, and gestational age at birth were available for 8024 women. Birthweight <5th percentile for gestational age occurred in 358 (4.5%) births. Typical thresholds for the uterine artery Doppler indices were all associated with birthweight <5th percentile for gestational age (P <.0001 for each), but the positive predictive values for these cutoffs were all <15% and areas under receiver operating characteristic curves ranged from 0.50-0.60. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.56-0.62. Incorporating maternal age, early pregnancy body mass index, race/ethnicity, smoking status prior to pregnancy, chronic hypertension, and pregestational diabetes in the prediction model resulted in only modest improvements in the areas under receiver operating characteristic curves ranging from 0.63-0.66. Conclusion In this large prospective cohort, early second-trimester uterine artery Doppler studies were not a clinically useful test for predicting small-for-gestational-age babies.

KW - Doppler ultrasound

KW - gestational hypertension

KW - small for gestational age

KW - spontaneous preterm birth

KW - uterine artery

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DO - 10.1016/j.ajog.2017.06.013

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SP - 594.e1-594.e10

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

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