{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T17:44:06Z","timestamp":1787247846540,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:00:00Z","timestamp":1620172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop further a new competing\u2010risks model for the prediction of a small\u2010for\u2010gestational\u2010age (SGA) neonate, by including second\u2010trimester ultrasonographic estimated fetal weight (EFW).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective observational study in 96\u2009678 women with singleton pregnancy undergoing routine ultrasound examination at 19\u201324\u2009weeks' gestation. All pregnancies had ultrasound biometry assessment, and EFW was calculated according to the Hadlock formula. We refitted in this large dataset a previously described competing\u2010risks model for the joint distribution of gestational age (GA) at delivery and birth\u2010weight <jats:italic>Z<\/jats:italic>\u2010score, according to maternal demographic characteristics and medical history, to obtain the prior distribution. The continuous likelihood of the EFW was fitted conditionally to GA at delivery and birth\u2010weight <jats:italic>Z<\/jats:italic>\u2010score and modified the prior distribution, according to Bayes' theorem, to obtain individualized distributions for GA at delivery and birth\u2010weight <jats:italic>Z<\/jats:italic>\u2010score and therefore patient\u2010specific risks for any cut\u2010offs for GA at delivery and birth\u2010weight <jats:italic>Z<\/jats:italic>\u2010score. We assessed the discriminative ability of the model for predicting SGA with, without or independently of pre\u2010eclampsia occurrence. A calibration study was carried out. Performance of screening was evaluated for SGA defined according to the Fetal Medicine Foundation birth\u2010weight charts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The distribution of EFW, conditional to both GA at delivery and birth\u2010weight <jats:italic>Z<\/jats:italic>\u2010score, was best described by a regression model. For earlier gestations, the association between EFW and birth weight was steeper. The prediction of SGA by maternal factors and EFW improved for increasing degree of prematurity and greater severity of smallness but not for coexistence of pre\u2010eclampsia. Screening by maternal factors predicted 31%, 34% and 39% of SGA neonates with birth weight &lt;\u200910<jats:sup>th<\/jats:sup> percentile delivered at \u2265\u200937, &lt;\u200937 and &lt;\u200930\u2009weeks' gestation, respectively, at a 10% false\u2010positive rate, and, after addition of EFW, these rates increased to 38%, 43% and 59%, respectively; the respective rates for birth weight &lt;\u20093<jats:sup>rd<\/jats:sup> percentile were 43%, 50% and 64%. The addition of EFW improved the calibration of the model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the competing\u2010risks model for prediction of SGA, the performance of screening by maternal characteristics and medical history is improved by the addition of second\u2010trimester EFW. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23593","type":"journal-article","created":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T15:07:36Z","timestamp":1611068856000},"page":"917-924","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Competing\u2010risks model for prediction of small\u2010for\u2010gestational\u2010age neonate from estimated fetal weight at 19\u201324\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":"U.","family":"Nowacka","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5856-6072","authenticated-orcid":false,"given":"A.","family":"Syngelaki","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Dragoi","sequence":"additional","affiliation":[{"name":"Fetal Medicine Research Institute King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Karamanis","sequence":"additional","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":"K. 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