The following is a summary of “Personalized stratification of pregnancy care for small for gestational age neonates from biophysical markers at midgestation,” published in the JULY 2023 issue of Obstetrics and Gynecology by Papastefanou, et al.

Identifying pregnancies at high risk of delivering small for gestational age (SGA) neonates is crucial for better management and improved perinatal outcomes. The use of a new competing-risks model for SGA prediction, incorporating maternal factors, estimated fetal weight, and uterine artery pulsatility index at midgestation, showed promising results compared to traditional methods. The next step involved the timely assessment of high-risk pregnancies through an antenatal stratification plan. For a study, researchers sought to illustrate the stratification of prenatal care based on individual patient risk generated from the competing-risks model for SGA, using maternal variables, sonographic estimated fetal weight, and midgestational uterine artery pulsatility index.

In the prospective observational study, 96,678 singleton pregnancies undergoing routine ultrasound examination between 19 to 24 weeks of gestation were included. The measurements of estimated fetal weight and uterine artery pulsatility index were recorded. The competing-risks model was employed to create patient-specific stratification curves, guiding the timing for a repeated ultrasound examination after 24 weeks. At any gestational age up until 36 weeks, various stratification schemes were examined to detect roughly 80%, 85%, 90%, and 95% of SGA neonates with birthweights <3rd and <10th percentiles, while all pregnancies would be given the option of a regular ultrasound examination at 36 weeks.

The stratification of pregnancy care for SGA can be effectively based on patient-specific curves, which consider maternal history, estimated fetal weight, and uterine artery pulsatility index to determine personalized risk levels. The degree of shifting in the risk curves influences the timing of assessments for each pregnancy. To detect 80%, 85%, 90%, and 95% of SGA neonates until 36 weeks, the median (range) proportions of the population examined per week were 3.15 (1.9–3.7), 3.85 (2.7–4.5), 4.75 (4.0–5.4), and 6.45 (3.7–8.0) for SGA <3rd percentile and 3.8 (2.5–4.6), 4.6 (3.6–5.4), 5.7 (3.8–6.4), and 7.35 (3.3–9.8) for SGA <10th percentile, respectively.

The application of the competing-risks model allowed for effective personalized stratification of pregnancy care for SGA, taking into account individual characteristics and biophysical markers obtained during midgestation scans.

Source: ajog.org/article/S0002-9378(22)02604-7/fulltext