Effectiveness of stratifying risk for fetal growth restriction in the routine antenatal ultrasound assessments at 11–14 weeks of gestation

AIM: The aim of the study was to determine the effectiveness of a first-trimester risk stratification algorithm to identify women at elevated risk for fetal growth restriction (FGR) in the 11–14-week ultrasound assessment. MATERIALS AND METHODS: Consecutive pregnant women were screened at the study center using ultrasound and fetal Doppler at 11–14 gestational weeks. The Fetal Medicine Foundation (FMF) algorithm was used to estimate the risk for FGR, with a 1 in 150 cutoff. FGR was considered an estimated fetal weight (EFW) <3 rd percentile, irrespective of fetal Doppler status or EFW 3 rd –10 th percentiles with abnormal fetal Doppler in the third trimester. Sensitivity, specificity, predictive values, odds ratio (OR), and area under the receiver operator characteristic (AUC) curve were estimated for the risk stratification model. RESULTS: First-trimester screening identified 242 (63.0%) of 384 women at elevated risk for FGR. The incidence of FGR in the third trimester was 6.3% ( n = 24). FGR developed in 22 (9.1%) of the 242 pregnant women at elevated risk and 2 (1.4%) of the 142 women at low risk for FGR in the first-trimester screening. The first-trimester risk stratification had a sensitivity of 91.7%, a negative predictive value of 98.6%, an AUC of 0.65, and an OR of 5.73 for FGR in the third trimester. CONCLUSION: Fetal ultrasound and Doppler integrated first-trimester risk stratification of pregnant women was useful to predict FGR in the third trimester.