A nomogram for predicting adverse perinatal outcome in patients with fetal growth restriction: A prospective observational study

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) combining ultrasonic and maternal serum biochemical indicators. Methods A total of 122 patients diagnosed with FGR were recruited for our prospective observational cohort study, who were randomly divided into a training and validation cohort at a ratio of 1:1. The primary composite APO comprised one or more of: birth weight below the 3rd percentile, perinatal death, impaired consciousness, asphyxia, seizures, assisted ventilation, septicemia, meningitis, bronchopulmonary dysplasia, intraventricular hemorrhage, cystic periventricular leukomalacia, and necrotizing enterocolitis. The stepwise regression based on the Akaike information criterion minimum was used to select variables for inclusion in the nomogram model. The discrimination and calibration of the nomogram were evaluated using receiver operating characteristic curve (AUC) and calibration plots. The net benefits of the nomogram at different threshold probabilities were quantified via decision curve analysis (DCA). Kaplan-Meier survival curves were constructed to analyze the primary outcome for risk stratifications. Results Three variables of abnormal umbilical artery (UA) Doppler, abnormal middle cerebral artery (MCA) Doppler, and log10(sFlt-1/PlGF) were selected to establish a nomogram. The C-index value of 0.79 and 0.75 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 in both cohorts. DCA manifested that the nomogram was clinically applicable, for it produced a better discriminative ability to identify those who carry a potentially high risk of APO. Conclusions A prognostic nomogram was developed and validated to possess the promising capacity of assisting clinicians in evaluating the prognosis of FGR patients.