American Journal of Obstetrics & Gynecology

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American Journal of Obstetrics & Gynecology Role of early second-trimester uterine artery Doppler screening to predict small-for- gestational-age babies in nulliparous women Samuel Parry, MD, Anthony Sciscione, DO, David M. Haas, MD, MS, William A. Grobman, MD, MBA, Jay D. Iams, MD, Brian M. Mercer, MD, Robert M. Silver, MD, Hyagriv N. Simhan, MD, Ronald J. Wapner, MD, Deborah A. Wing, MD, MBA, Michal A. Elovitz, MD, Frank P. Schubert, MD, Alan Peaceman, MD, M. Sean Esplin, MD, Steve Caritis, MD, Michael P. Nageotte, MD, Benjamin A. Carper, MS, George R. Saade, MD, Uma M. Reddy, MD, MPH, Corette B. Parker, DrPH American Journal of Obstetrics & Gynecology DOI: 10.1016/j.ajog.2017.06.013 Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 1 Flowchart of nuMoM2b study participants Participant flow chart demonstrates that 10,038 women were enrolled into Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b); 9473 delivered >20 weeks and 8050 underwent successful uterine artery Doppler (UAD) studies between 16 weeks 0 days and 22 weeks 6 days (excluding fetal demise, bradycardia, tachycardia, major structural malformation, and hydrops). For 8050 women with UAD measurements: 8024 could be used in analysis on small for gestational age; 8033 on hypertensive disorders of pregnancy; 8046 on spontaneous preterm birth; and all 8050 on stillbirth. Parry et al. Uterine artery Dopplers in nulliparous women. Am J Obstet Gynecol 2017. American Journal of Obstetrics & Gynecology DOI: (10.1016/j.ajog.2017.06.013) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 2 Receiver operator characteristic curves demonstrating uterine artery Doppler thresholds Receiver operator characteristic (ROC) curves were generated to demonstrate ability of uterine artery Doppler measurements to predict small for gestational age (birthweight <5th percentile for gestational age at delivery). A, Contrasts diastolic notch depth, resistance index (RI), and pulsatility index (PI) on continuous scales. B, Contrasts diastolic notch depth thresholds. C, Contrasts RI thresholds. D, Contrasts PI thresholds. Suggested thresholds are from literature. Optimized thresholds are those maximizing sum of sensitivity and specificity. Parry et al. Uterine artery Dopplers in nulliparous women. Am J Obstet Gynecol 2017. American Journal of Obstetrics & Gynecology DOI: (10.1016/j.ajog.2017.06.013) Copyright © 2017 Elsevier Inc. Terms and Conditions

Figure 3 Receiver operator characteristic curves demonstrating the ability of uterine artery Dopplers to predict small for gestational age outcomes Receiver operator characteristic (ROC) curves were generated to demonstrate ability of uterine artery Doppler measurements and maternal demographic variables to predict small for gestational age (birthweight <5th percentile for gestational age at delivery). Demographic variables included in predictive model included early pregnancy body mass index, race/ethnicity, smoking, maternal age, chronic hypertension, and pregestational diabetes. A, Contrasts diastolic notch depth, resistance index (RI), and pulsatility index (PI) on continuous scales. B, Contrasts diastolic notch depth thresholds. C, Contrasts RI thresholds. D, Contrasts PI thresholds. Suggested thresholds are from literature. Optimized thresholds are those maximizing sum of sensitivity and specificity. Parry et al. Uterine artery Dopplers in nulliparous women. Am J Obstet Gynecol 2017. American Journal of Obstetrics & Gynecology DOI: (10.1016/j.ajog.2017.06.013) Copyright © 2017 Elsevier Inc. Terms and Conditions