External validation of Fetal Medicine Foundation competing‐risks model for midgestation prediction of small‐for‐gestational‐age neonates in Spanish population

Abstract

ABSTRACTObjectiveTo examine the external validity of the new Fetal Medicine Foundation (FMF) competing‐risks model for prediction in midgestation of small‐for‐gestational‐age (SGA) neonates.MethodsThis was a single‐center prospective cohort study of 25 484 women with a singleton pregnancy undergoing routine ultrasound examination at 19 + 0 to 23 + 6 weeks' gestation. The FMF competing‐risks model for the prediction of SGA combining maternal factors and midgestation estimated fetal weight by ultrasound scan (EFW) and uterine artery pulsatility index (UtA‐PI) was used to calculate risks for different cut‐offs of birth‐weight percentile and gestational age at delivery. The predictive performance was evaluated in terms of discrimination and calibration.ResultsThe validation cohort was significantly different in composition compared with the FMF cohort in which the model was developed. In the validation cohort, at a 10% false‐positive rate (FPR), maternal factors, EFW and UtA‐PI yielded detection rates of 69.6%, 38.7% and 31.7% for SGA < 10th percentile with delivery at < 32, < 37 and ≥ 37 weeks' gestation, respectively. The respective values for SGA < 3rd percentile were 75.7%, 48.2% and 38.1%. Detection rates in the validation cohort were similar to those reported in the FMF study for SGA with delivery at < 32 weeks but lower for SGA with delivery at < 37 and ≥ 37 weeks. Predictive performance in the validation cohort was similar to that reported in a subgroup of the FMF cohort consisting of nulliparous and Caucasian women. Detection rates in the validation cohort at a 15% FPR were 77.4%, 50.0% and 41.5% for SGA < 10th percentile with delivery at < 32, < 37 and ≥ 37 weeks, respectively, which were similar to the respective values reported in the FMF study at a 10% FPR. The model had satisfactory calibration.ConclusionThe new competing‐risks model for midgestation prediction of SGA developed by the FMF performs well in a large independent Spanish population. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.