{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T17:09:42Z","timestamp":1783357782813,"version":"3.54.6"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T00:00:00Z","timestamp":1613347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003123","name":"Fetal Medicine Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003123","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To expand a new competing\u2010risks model for prediction of a small\u2010for\u2010gestational\u2010age (SGA) neonate, by the addition of pregnancy\u2010associated plasma protein\u2010A (PAPP\u2010A) and placental growth factor (PlGF), and to evaluate and compare PAPP\u2010A and PlGF in predicting SGA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective observational study of 60\u2009875 women with singleton pregnancy undergoing routine ultrasound examination at 11\u2009+\u20090 to 13\u2009+\u20096\u2009weeks' gestation. We fitted a folded\u2010plane regression model for the PAPP\u2010A and PlGF likelihoods. A previously developed maternal history model and the likelihood models were combined, according to Bayes' theorem, to obtain individualized distributions for gestational age (GA) at delivery and birth\u2010weight <jats:italic>Z<\/jats:italic>\u2010score. We assessed the discrimination and calibration of the model. McNemar's test was used to compare the detection rates for SGA with, without or independently of pre\u2010eclampsia (PE) occurrence, of different combinations of maternal history, PAPP\u2010A and PlGF, for a fixed false\u2010positive rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The distributions of PAPP\u2010A and PlGF depend on both GA at delivery and birth\u2010weight <jats:italic>Z<\/jats:italic>\u2010score, in the same continuous likelihood, according to a folded\u2010plane regression model. The new approach offers the capability for risk computation for any desired birth\u2010weight <jats:italic>Z<\/jats:italic>\u2010score and GA at delivery cut\u2010off. PlGF was consistently and significantly better than PAPP\u2010A in predicting SGA delivered before 37\u2009weeks, especially in cases with co\u2010existence of PE. PAPP\u2010A had similar performance to PlGF for the prediction of SGA without PE. At a fixed false\u2010positive rate of 10%, the combination of maternal history, PlGF and PAPP\u2010A predicted 33.8%, 43.8% and 48.4% of all cases of a SGA neonate with birth weight &lt;\u200910<jats:sup>th<\/jats:sup> percentile delivered at \u2265\u200937, &lt;\u200937 and &lt;\u200932\u2009weeks' gestation, respectively. The respective values for birth weight &lt;\u20093<jats:sup>rd<\/jats:sup> percentile were 38.6%, 48.7% and 51.0%. The new model performed well in terms of risk calibration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The combination of PAPP\u2010A and PlGF values with maternal characteristics, according to Bayes' theorem, improves prediction of SGA. PlGF is a better predictor of SGA than PAPP\u2010A, especially when PE is present. The new competing\u2010risks model for SGA can be tailored to each pregnancy and to the relevant clinical requirements. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23118","type":"journal-article","created":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T22:29:00Z","timestamp":1600295340000},"page":"392-400","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Competing\u2010risks model for prediction of small\u2010for\u2010gestational\u2010age neonate from maternal characteristics, serum pregnancy\u2010associated plasma <scp>protein\u2010A<\/scp> and placental growth factor at 11\u201313\u2009weeks' gestation"],"prefix":"10.1002","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7969-1435","authenticated-orcid":false,"given":"I.","family":"Papastefanou","sequence":"first","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Wright","sequence":"additional","affiliation":[{"name":"Institute of Health Research University of Exeter  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Lolos","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Anampousi","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Mamalis","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. H.","family":"Nicolaides","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.06.039"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.02.030"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.233"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182a265ab"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003081-200606000-00009"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1806"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.12.004"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13723"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.01.227"},{"key":"e_1_2_8_11_1","unstructured":"Royal College of Obstetricians and Gynaecologists.The Investigation and management of the small\u2013for\u2013gestational\u2013age fetus. 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