A Novel Approach to Predicting Early Pregnancy Outcomes Dynamically in a Prospective Cohort Using Repeated Ultrasound and Serum Biomarkers

Jesper Friis Petersen*, Lennart Jan Friis-Hansen, Thue Bryndorf, Andreas Kryger Jensen, Anders Nyboe Andersen, Ellen Løkkegaard


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This study aimed to develop a dynamic model for predicting outcome during the first trimester of pregnancy using baseline demographic data and serially collected blood samples and transvaginal sonographies. A prospective cohort of 203 unselected women with an assumed healthy pregnancy of < 8 weeks’ gestation was followed fortnightly from 4–14 weeks’ gestation until either miscarriage or confirmed first trimester viability. The main outcome was development of a model to predict outcome from gestational age-dependent hazard ratios using both baseline and updated serial data from each visit. Secondary outcomes were descriptions of risk factors for miscarriage. The results showed that 18% of the women experienced miscarriages. A fetal heart rate detected before 8 weeks’ gestation indicated a 90% (95% CI 85–95%) chance of subsequent delivery. Maternal age (≥ 35 years), insufficient crown-rump-length (CRL) and mean gestational sac diameter (MSD) development, and presence of bleeding increased the risk of miscarriage. Serum biomarkers, including hCG, progesterone, and estradiol, were found to impact the risk of miscarriage with estradiol as the most important. The best model to predict miscarriage was a combination of maternal age, vaginal bleeding, CRL, and hCG. The second-best model was the sonography-absent model of maternal age, bleeding, hCG, and estradiol. This study suggests that combining maternal age, and evolving data from hCG, estradiol, CRL, and bleeding could be used to predict fetal outcome during the first trimester of pregnancy. Trial registration ClinicalTrials.gov identifier: NCT02761772.

TidsskriftReproductive Sciences
Udgave nummer12
Sider (fra-til)3597-3609
StatusUdgivet - dec. 2023

Bibliografisk note

Funding Information:
Open access funding provided by Royal Library, Copenhagen University Library This study was funded by generous grants from the North Zealand Hospital Research Council, the Gangsted Foundation, the Foundation for Development of Danish Private Practice, the Tvergaard Foundation, the AP Møller Foundation, the Foundation from Danish Doctors Pension, Copenhagen University and the Danish Southern and Zealand Region. No funders were involved in the design, acquisition, analyses or interpretation of data prior to submission.


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