First-trimester screening for fetal growth restriction using Doppler color flow analysis of the uterine artery and serum PAPP-A levels in unselected pregnancies

To explore an early diagnostic model for fetal growth restriction (FGR) at 11–13 (+6 days) gestational weeks using Doppler analysis of the uterine artery and measurements of pregnancy-associated plasma protein-A (PAPP-A). This was a prospective study which included 1796 singleton pregnant women, who received routine pregnancy examination at 11–13 (+6 days) gestational weeks in Shanghai Changning Maternity and Infant Health Hospital between 1 June 2017 and 31 July 2018. Uterine artery pulsatility index (PI), uterine resistance index (RI), and notching were recorded using the Doppler ultrasound detector (Voluson E8; GE Healthcare, Kretztechnik, Zipf, Austria). Maternal serum PAPP-A was assayed using time-resolved fluorescence immunoassay (Perkin-Elmer Life Sciences, Waltham, MA, USA) and analyzed using Fetal Medicine Foundation software. Maternal and neonatal outcomes were followed. Out of 1796 pregnant women aged 18–42 years, 76 (4.2%) mothers had FGR fetus. In the FGR fetuses, the mean uterine artery PI and RI were higher, the PAPP-A levels were 0.42-fold lower (all <i>p</i> values p p values The combination of uterine artery PI and PAPP-A measured at 11–13 (+6 days) gestational weeks provides a sensitive and specific predictor for early diagnosis of FGR.

本研究旨在构建基于妊娠11~13(+6)周子宫动脉多普勒分析与妊娠相关血浆蛋白-A(PAPP-A)检测的胎儿生长受限(FGR)早期诊断模型。本研究为前瞻性队列研究，纳入2017年6月1日至2018年7月31日期间，于上海市长宁区妇幼保健院接受11~13(+6)周常规产前检查的1796名单胎妊娠孕妇。采用多普勒超声检测仪（Voluson E8；GE Healthcare，Kretztechnik，奥地利Zipf）记录子宫动脉搏动指数(PI)、子宫动脉阻力指数(RI)及切迹情况。孕妇血清PAPP-A水平采用时间分辨荧光免疫分析法（Perkin-Elmer Life Sciences，美国马萨诸塞州沃尔瑟姆）检测，并通过胎儿医学基金会软件进行数据分析。对所有研究对象的母儿结局进行随访追踪。本研究纳入的1796名孕妇年龄介于18~42岁，其中76名（4.2%）孕妇孕育FGR胎儿。相较于非FGR组，FGR胎儿孕妇的子宫动脉PI及RI均值更高，血清PAPP-A水平仅为对照组的0.42倍（所有差异均具有统计学意义，原文此处存在排版疏漏）。于妊娠11~13(+6)周检测的子宫动脉PI联合PAPP-A水平，可作为FGR早期诊断的灵敏且特异的预测指标。