Clinical prediction in early pregnancy of infants small for gestational age by customised birthweight centiles: findings from a healthy nulliparous cohort

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dc.contributor.authorMcCowan, Lesley M. E.
dc.contributor.authorThompson, John M. D.
dc.contributor.authorTaylor, Rennae S.
dc.contributor.authorNorth, Robyn A.
dc.contributor.authorPoston, Lucilla
dc.contributor.authorBaker, Philip N.
dc.contributor.authorMyers, Jenny
dc.contributor.authorRoberts, Claire T.
dc.contributor.authorDekker, Gustaaf A.
dc.contributor.authorSimpson, Nigel A. B.
dc.contributor.authorWalker, James J.
dc.contributor.authorKenny, Louise C.
dc.contributor.funderFoundation for Research, Science and Technology, New Zealanden
dc.contributor.funderHealth Research Council, New Zealanden
dc.contributor.funderEvelyn Bond Fund, New Zealanden
dc.contributor.funderAuckland District Health Board Charitable Trust, New Zealanden
dc.contributor.funderPremier’s Science and Research Fund, Australiaen
dc.contributor.funderGovernment of South Australiaen
dc.contributor.funderGuy’s and St Thomas’ Charity, United Kingdomen
dc.contributor.funderTommy's Baby Charityen
dc.contributor.funderBiotechnology and Biological Sciences Research Councilen
dc.contributor.funderNational Health Service, United Kingdomen
dc.contributor.funderUniversity of Manchester, United Kingdomen
dc.contributor.funderNational Institute for Health Research, United Kingdomen
dc.contributor.funderCerebra, United Kingdomen
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2016-02-17T11:45:32Z
dc.date.available2016-02-17T11:45:32Z
dc.date.issued2013
dc.description.abstractObjective: Small for gestational age (SGA) infants comprise up to 50% of all stillbirths and a minority are detected before birth. We aimed to develop and validate early pregnancy predictive models for SGA infants. Methods: 5628 participants from SCOPE, a prospective study of nulliparous pregnant women, were interviewed at 15 +/- 1 weeks' gestation. Fetal anthropometry, uterine and umbilical Doppler studies were performed at 20 +/- 1 weeks'. The cohort was divided into training (n = 3735) and validation datasets (n = 1871). All-SGA (birthweight,10th customised centile), Normotensive-SGA (SGA with normotensive mother) and Hypertensive-SGA (SGA with mother who developed hypertension) were the primary outcomes. Multivariable analysis was performed using stepwise logistic regression firstly using clinical variables and then with clinical and ultrasound variables. Receiver operator curves were constructed and areas under the curve (AUC) calculated. Results: 633 infants (11.3%) in the whole cohort were SGA; 465 (8.3%) Normotensive-SGA and 165 (3.0%) Hypertensive-SGA. In the training dataset risk factors for All- SGA at 1561 weeks' included: family history of coronary heart disease, maternal birthweight <3000 g and 3000 g to 3499 g compared with >= 3500 g, >12 months to conceive, university student, cigarette smoking, proteinuria, daily vigorous exercise and diastolic blood pressure >= 80. Recreational walking >= 4 times weekly, rhesus negative blood group and increasing random glucose were protective. AUC for clinical risk factors was 0.63. Fetal abdominal or head circumference z scores <10th centile and increasing uterine artery Doppler resistance at 20 +/- 1 weeks' were associated with increased risk. Addition of these parameters increased the AUC to 0.69. Clinical predictors of Normotensive and Hypertensive-SGA were sub-groups of All-SGA predictors and were quite different. The combined clinical and ultrasound AUC for Normotensive and Hypertensive-SGA were 0.69 and 0.82 respectively. Conclusion: Predictors for SGA of relevance to clinical practice were identified. The identity and predictive potential differed in normotensive women and those who developed hypertension.en
dc.description.sponsorshipFoundation for Research Science and Technology, New Zealand (New Enterprise Research Fund (EM 04-05/03)); Health Research Council, New Zealand (04/198); Government of South Australia (Premier's Science and Research Fund); Biotechnology and Biological Sciences Research Council, United Kingdom (GT084); National Health Service, United Kingdom (NEAT FSD025); University of Manchester (Proof of Concept Funding); Health Research Board, Ireland (CSA/2007/2)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleide70917
dc.identifier.citationMcCowan LME, Thompson JMD, Taylor RS, North RA, Poston L, Baker PN, et al. (2013) Clinical Prediction in Early Pregnancy of Infants Small for Gestational Age by Customised Birthweight Centiles: Findings from a Healthy Nulliparous Cohort. PLoS ONE 8(8): e70917. doi:10.1371/journal.pone.0070917en
dc.identifier.doi10.1371/journal.pone.0070917
dc.identifier.issn1932-6203
dc.identifier.issued8en
dc.identifier.journaltitlePLOS ONEen
dc.identifier.urihttps://hdl.handle.net/10468/2369
dc.identifier.volume8en
dc.language.isoenen
dc.publisherPublic Library of Scienceen
dc.rights© 2013 McCowan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are crediteden
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectInternational prospective cohorten
dc.subjectHypertensive disordersen
dc.subjectFetal growthen
dc.subject1st trimester predictionen
dc.subjectPreeclampsiaen
dc.subjectRisken
dc.subjectExerciseen
dc.subjectRestrictionen
dc.subjectManagementen
dc.subjectOutcomesen
dc.titleClinical prediction in early pregnancy of infants small for gestational age by customised birthweight centiles: findings from a healthy nulliparous cohorten
dc.typeArticle (peer-reviewed)en
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