Development and Validation of Composite Diagnostic Score for IUGR Using Morphometry and Oxidative Stress Parameters

Abstract

Intrauterine growth restriction (IUGR) is a major complication during childbirth leading to elevated perinatal morbidity and death rates. Heterogeneous etiologies and overlapping presentation complicate the early and accurate diagnosis of the disorder. The purpose of this study was to construct and test a composite diagnostic score with morphometric evaluation of the umbilical cord and oxidative stress indicators to enhance the ability to detect IUGR. 155 expectant women who were diagnosed with IUGR and 155 age-matched controls at gestational age were enrolled. Morphometric measurements of umbilical vessel wall thickness, lumen diameter and Wharton jelly area were taken. Malondialdehyde (MDA), superoxide dismutase (SOD) and total antioxidant capacity (TAC), were measured in the maternal serum. A composite score was calculated with multivariate logistic regression and tested with receiver operating characteristic (ROC). The composite score was highly diagnostic with an area under the curve (AUC) of 0.91, sensitivity of 88 and specificity of 85. The morphometric and oxidative markers had a moderate diagnostic value on their own, but when combined, the predictive value increased significantly. Composite diagnostic score could be effectively used as a clinical tool to diagnose IUGR pregnancies to help intervene in time and achieve better neonatal outcomes. Its clinical applicability should be confirmed by further large-scale prospective studies