1. A nomogram for predicting adverse perinatal outcome with fetal growth restriction: a prospective observational study.
- Author
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Zhao Y, Xu L, An P, Zhou J, Zhu J, Liu S, Zhou Q, Li X, and Xiong Y
- Subjects
- Humans, Female, Pregnancy, Prospective Studies, Adult, Infant, Newborn, Pregnancy Outcome epidemiology, Ultrasonography, Prenatal, Risk Assessment methods, Gestational Age, Umbilical Arteries diagnostic imaging, ROC Curve, Fetal Growth Retardation blood, Fetal Growth Retardation diagnosis, Nomograms
- Abstract
Background: Fetal growth restriction (FGR) is a major determinant of perinatal morbidity and mortality. Our study aimed to develop a prediction model for the risk of FGR developing adverse perinatal outcome (APO) and evaluate its performance., Methods: This was a prospective observational cohort study of consecutive singleton gestations meeting the ACOG-endorsed criteria for FGR from January 2022 to June 2023 at Obstetrics and Gynecology Hospital of Fudan University. Clinical information, ultrasound indicators and serum biomarkers were collected. The primary composite APO comprised one or more of: perinatal death, intrauterine demise, intraventricular hemorrhage, periventricular leukomalacia, seizures, necrotizing enterocolitis, neonatal respiratory distress syndrome, sepsis and the length of stay in the neonatal intensive care unit > 7 days. Least absolute shrinkage and selection operator regression was used to screen variables for nomogram model construction. The discrimination, calibration and clinical effectiveness of the nomogram were evaluated using receiver operating characteristic curve, calibration plots and decision curve analysis in training and validation cohorts., Results: A total of 122 pregnancies were enrolled in the final statistical analysis. Five variables were identified to establish a nomogram, including gestational weeks at diagnosis, abnormal umbilical artery Doppler, abnormal uterine artery Doppler, and multiples of the median values of placental growth factor and soluble fms-like tyrosine kinase-1. The area under the receiver-operating-characteristics curve of 0.87 (95% CI, 0.75-0.99) and 0.86 (95% CI, 0.74-0.98) in the training and validation cohort respectively, indicated satisfactory discriminative ability of the nomogram. The calibration plots showed favorable consistency between the nomogram's predictions and actual observations. Decision curve analysis supported its practical value in a clinical setting., Conclusions: A nomogram was developed and validated to possess the promising capacity of predicting APO in FGR-afflicted neonates, and may prove useful in counseling and management of pregnancies complicated by FGR., Competing Interests: Declarations. Ethics approval and consent to participate: The Ethics Committee of the Gynecology and Obstetrics Hospital of Fudan University reviewed and approved all the study procedures (approval number 2022-18). All participants were fully informed of the content and purpose of the study and provided written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)
- Published
- 2025
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