Ultrasound measurement of the fetal adrenal gland as a predictor of spontaneous preterm birth

Matthew K. Hoffman, Ozhan M. Turan, Corette B. Parker, Ronald J. Wapner, Deborah A. Wing, David M. Haas, M. Sean Esplin, Samuel Parry, William A. Grobman, Hyagriv N. Simhan, Stephen Myers, Tommy E. Holder, Pamela Rumney, Christian G. Litton, Robert M. Silver, Michal A. Elovitz, Alan M. Peaceman, Stephen Emery, Brian M. Mercer, Matthew A. KochGeorge Saade

    Research output: Contribution to journalArticle

    5 Citations (Scopus)

    Abstract

    OBJECTIVE: To estimate whether ultrasound measurement of the fetal adrenal gland remote from delivery in asymptomatic women can accurately predict spontaneous preterm birth. METHODS: We conducted a prospective multicenter observational nested cohort study of asymptomatic nulliparous women with a singleton pregnancy to study adverse pregnancy outcomes. Between 22 0/7 and 30 6/7 weeks of gestation, credentialed ultrasonographers measured the width (width), length (length), and, when able, depth (depth) of the "fetal zone" of the fetal adrenal gland as well as the width (Width), length (Length), and depth (Depth) of the total gland. We used the ratios of each measurement (width/Width, length/Length, and depth/Depth) to control for variation in adrenal size by gestational age. The accuracy of each ratio measurement in predicting spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation was assessed by receiver operating characteristic curves using area under the curve. RESULTS: Pregnancy outcomes were available for 1,697 women with one or more fetal adrenal gland measurements. Spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation occurred in 82 (4.8%) and six women (0.4%), respectively. None of the fetal adrenal gland measurements distinguished spontaneous preterm birth from term birth. The areas under the curve (95% confidence intervals) for spontaneous preterm birth at less than 37 0/7 weeks of gestation were 0.51 (0.45-0.58), 0.50 (0.44-0.56), and 0.52 (0.41-0.63) for width/Width, length/Length, and depth/Depth ratios, respectively. The areas under the curve for spontaneous preterm birth at less than 34 0/7 weeks of gestation were 0.52 (0.25-0.79) and 0.55 (0.31-0.79) for width/Width and length/Length ratios, respectively. Additionally, none of the means of the gland measurements were statistically different between those delivering at term and spontaneous at preterm (P>.05). CONCLUSION: Fetal adrenal size, as measured by ultrasonography between 22 0/7 and 30 6/7 weeks of gestation, is not predictive of spontaneous preterm birth in asymptomatic nulliparous women.

    Original languageEnglish (US)
    Pages (from-to)726-734
    Number of pages9
    JournalObstetrics and Gynecology
    Volume127
    Issue number4
    DOIs
    StatePublished - Apr 1 2016

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    Premature Birth
    Adrenal Glands
    Pregnancy
    Area Under Curve
    Pregnancy Outcome
    Term Birth
    ROC Curve
    Gestational Age
    Ultrasonography
    Cohort Studies
    Confidence Intervals

    ASJC Scopus subject areas

    • Obstetrics and Gynecology

    Cite this

    Ultrasound measurement of the fetal adrenal gland as a predictor of spontaneous preterm birth. / Hoffman, Matthew K.; Turan, Ozhan M.; Parker, Corette B.; Wapner, Ronald J.; Wing, Deborah A.; Haas, David M.; Esplin, M. Sean; Parry, Samuel; Grobman, William A.; Simhan, Hyagriv N.; Myers, Stephen; Holder, Tommy E.; Rumney, Pamela; Litton, Christian G.; Silver, Robert M.; Elovitz, Michal A.; Peaceman, Alan M.; Emery, Stephen; Mercer, Brian M.; Koch, Matthew A.; Saade, George.

    In: Obstetrics and Gynecology, Vol. 127, No. 4, 01.04.2016, p. 726-734.

    Research output: Contribution to journalArticle

    Hoffman, MK, Turan, OM, Parker, CB, Wapner, RJ, Wing, DA, Haas, DM, Esplin, MS, Parry, S, Grobman, WA, Simhan, HN, Myers, S, Holder, TE, Rumney, P, Litton, CG, Silver, RM, Elovitz, MA, Peaceman, AM, Emery, S, Mercer, BM, Koch, MA & Saade, G 2016, 'Ultrasound measurement of the fetal adrenal gland as a predictor of spontaneous preterm birth', Obstetrics and Gynecology, vol. 127, no. 4, pp. 726-734. https://doi.org/10.1097/AOG.0000000000001342
    Hoffman, Matthew K. ; Turan, Ozhan M. ; Parker, Corette B. ; Wapner, Ronald J. ; Wing, Deborah A. ; Haas, David M. ; Esplin, M. Sean ; Parry, Samuel ; Grobman, William A. ; Simhan, Hyagriv N. ; Myers, Stephen ; Holder, Tommy E. ; Rumney, Pamela ; Litton, Christian G. ; Silver, Robert M. ; Elovitz, Michal A. ; Peaceman, Alan M. ; Emery, Stephen ; Mercer, Brian M. ; Koch, Matthew A. ; Saade, George. / Ultrasound measurement of the fetal adrenal gland as a predictor of spontaneous preterm birth. In: Obstetrics and Gynecology. 2016 ; Vol. 127, No. 4. pp. 726-734.
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    abstract = "OBJECTIVE: To estimate whether ultrasound measurement of the fetal adrenal gland remote from delivery in asymptomatic women can accurately predict spontaneous preterm birth. METHODS: We conducted a prospective multicenter observational nested cohort study of asymptomatic nulliparous women with a singleton pregnancy to study adverse pregnancy outcomes. Between 22 0/7 and 30 6/7 weeks of gestation, credentialed ultrasonographers measured the width (width), length (length), and, when able, depth (depth) of the {"}fetal zone{"} of the fetal adrenal gland as well as the width (Width), length (Length), and depth (Depth) of the total gland. We used the ratios of each measurement (width/Width, length/Length, and depth/Depth) to control for variation in adrenal size by gestational age. The accuracy of each ratio measurement in predicting spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation was assessed by receiver operating characteristic curves using area under the curve. RESULTS: Pregnancy outcomes were available for 1,697 women with one or more fetal adrenal gland measurements. Spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation occurred in 82 (4.8{\%}) and six women (0.4{\%}), respectively. None of the fetal adrenal gland measurements distinguished spontaneous preterm birth from term birth. The areas under the curve (95{\%} confidence intervals) for spontaneous preterm birth at less than 37 0/7 weeks of gestation were 0.51 (0.45-0.58), 0.50 (0.44-0.56), and 0.52 (0.41-0.63) for width/Width, length/Length, and depth/Depth ratios, respectively. The areas under the curve for spontaneous preterm birth at less than 34 0/7 weeks of gestation were 0.52 (0.25-0.79) and 0.55 (0.31-0.79) for width/Width and length/Length ratios, respectively. Additionally, none of the means of the gland measurements were statistically different between those delivering at term and spontaneous at preterm (P>.05). CONCLUSION: Fetal adrenal size, as measured by ultrasonography between 22 0/7 and 30 6/7 weeks of gestation, is not predictive of spontaneous preterm birth in asymptomatic nulliparous women.",
    author = "Hoffman, {Matthew K.} and Turan, {Ozhan M.} and Parker, {Corette B.} and Wapner, {Ronald J.} and Wing, {Deborah A.} and Haas, {David M.} and Esplin, {M. Sean} and Samuel Parry and Grobman, {William A.} and Simhan, {Hyagriv N.} and Stephen Myers and Holder, {Tommy E.} and Pamela Rumney and Litton, {Christian G.} and Silver, {Robert M.} and Elovitz, {Michal A.} and Peaceman, {Alan M.} and Stephen Emery and Mercer, {Brian M.} and Koch, {Matthew A.} and George Saade",
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    TY - JOUR

    T1 - Ultrasound measurement of the fetal adrenal gland as a predictor of spontaneous preterm birth

    AU - Hoffman, Matthew K.

    AU - Turan, Ozhan M.

    AU - Parker, Corette B.

    AU - Wapner, Ronald J.

    AU - Wing, Deborah A.

    AU - Haas, David M.

    AU - Esplin, M. Sean

    AU - Parry, Samuel

    AU - Grobman, William A.

    AU - Simhan, Hyagriv N.

    AU - Myers, Stephen

    AU - Holder, Tommy E.

    AU - Rumney, Pamela

    AU - Litton, Christian G.

    AU - Silver, Robert M.

    AU - Elovitz, Michal A.

    AU - Peaceman, Alan M.

    AU - Emery, Stephen

    AU - Mercer, Brian M.

    AU - Koch, Matthew A.

    AU - Saade, George

    PY - 2016/4/1

    Y1 - 2016/4/1

    N2 - OBJECTIVE: To estimate whether ultrasound measurement of the fetal adrenal gland remote from delivery in asymptomatic women can accurately predict spontaneous preterm birth. METHODS: We conducted a prospective multicenter observational nested cohort study of asymptomatic nulliparous women with a singleton pregnancy to study adverse pregnancy outcomes. Between 22 0/7 and 30 6/7 weeks of gestation, credentialed ultrasonographers measured the width (width), length (length), and, when able, depth (depth) of the "fetal zone" of the fetal adrenal gland as well as the width (Width), length (Length), and depth (Depth) of the total gland. We used the ratios of each measurement (width/Width, length/Length, and depth/Depth) to control for variation in adrenal size by gestational age. The accuracy of each ratio measurement in predicting spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation was assessed by receiver operating characteristic curves using area under the curve. RESULTS: Pregnancy outcomes were available for 1,697 women with one or more fetal adrenal gland measurements. Spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation occurred in 82 (4.8%) and six women (0.4%), respectively. None of the fetal adrenal gland measurements distinguished spontaneous preterm birth from term birth. The areas under the curve (95% confidence intervals) for spontaneous preterm birth at less than 37 0/7 weeks of gestation were 0.51 (0.45-0.58), 0.50 (0.44-0.56), and 0.52 (0.41-0.63) for width/Width, length/Length, and depth/Depth ratios, respectively. The areas under the curve for spontaneous preterm birth at less than 34 0/7 weeks of gestation were 0.52 (0.25-0.79) and 0.55 (0.31-0.79) for width/Width and length/Length ratios, respectively. Additionally, none of the means of the gland measurements were statistically different between those delivering at term and spontaneous at preterm (P>.05). CONCLUSION: Fetal adrenal size, as measured by ultrasonography between 22 0/7 and 30 6/7 weeks of gestation, is not predictive of spontaneous preterm birth in asymptomatic nulliparous women.

    AB - OBJECTIVE: To estimate whether ultrasound measurement of the fetal adrenal gland remote from delivery in asymptomatic women can accurately predict spontaneous preterm birth. METHODS: We conducted a prospective multicenter observational nested cohort study of asymptomatic nulliparous women with a singleton pregnancy to study adverse pregnancy outcomes. Between 22 0/7 and 30 6/7 weeks of gestation, credentialed ultrasonographers measured the width (width), length (length), and, when able, depth (depth) of the "fetal zone" of the fetal adrenal gland as well as the width (Width), length (Length), and depth (Depth) of the total gland. We used the ratios of each measurement (width/Width, length/Length, and depth/Depth) to control for variation in adrenal size by gestational age. The accuracy of each ratio measurement in predicting spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation was assessed by receiver operating characteristic curves using area under the curve. RESULTS: Pregnancy outcomes were available for 1,697 women with one or more fetal adrenal gland measurements. Spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation occurred in 82 (4.8%) and six women (0.4%), respectively. None of the fetal adrenal gland measurements distinguished spontaneous preterm birth from term birth. The areas under the curve (95% confidence intervals) for spontaneous preterm birth at less than 37 0/7 weeks of gestation were 0.51 (0.45-0.58), 0.50 (0.44-0.56), and 0.52 (0.41-0.63) for width/Width, length/Length, and depth/Depth ratios, respectively. The areas under the curve for spontaneous preterm birth at less than 34 0/7 weeks of gestation were 0.52 (0.25-0.79) and 0.55 (0.31-0.79) for width/Width and length/Length ratios, respectively. Additionally, none of the means of the gland measurements were statistically different between those delivering at term and spontaneous at preterm (P>.05). CONCLUSION: Fetal adrenal size, as measured by ultrasonography between 22 0/7 and 30 6/7 weeks of gestation, is not predictive of spontaneous preterm birth in asymptomatic nulliparous women.

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