Utility of placental biomarkers and fetoplacental Dopplers in predicting likely placental pathology in early and late fetal growth restriction – A prospective study

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dc.contributor.authorHong, J.
dc.contributor.authorCrawford, K.
dc.contributor.authorDaly, M.
dc.contributor.authorClifton, V.
dc.contributor.authorda Silva Costa, F.
dc.contributor.authorPerkins, A.V.
dc.contributor.authorMatsika, A.
dc.contributor.authorLourie, R.
dc.contributor.authorKumar, S.
dc.date.issued2024
dc.description.abstractIntroduction: The aim of this study was to evaluate the association between placental abnormalities, placental biomarkers, and fetoplacental Dopplers in a cohort of pregnancies complicated by fetal growth restriction (FGR). We also ascertained the risk of perinatal mortality, severe neurological morbidity, and severe non-neurological morbidity by type of placental abnormality. Methods: This was a prospective cohort study. Multivariable logistic regression was used to evaluate the effect of early vs. late FGR, placental biomarkers and fetoplacental Dopplers on Maternal Vascular Malperfusion (MVM) which was the commonest placental abnormality identified. Results: There were 161 (53.5 %) early FGR and 140 (46.5 %) late FGR cases. MVM abnormalities were present in 154 (51.2 %), VUE in 45 (14.6 %), FVM in 16 (5.3 %), DVM in 14 (4.7 %) and CHI in 4 (1.3 %) cases. The odds of MVM were higher in early compared to late FGR cohort (OR 1.89, 95%CI 1.14, 3.14, p = 0.01). Low maternal PlGF levels <100 ng/L (OR 2.34, 95%CI 1.27,4.31, p = 0.01), high sFlt-1 level (OR 2.13, 95%CI 1.35, 3.36, p = 0.001) or elevated sFlt-1/PlGF ratio (OR 3.48, 95%CI 1.36, 8.91, p = 0.01) were all associated with MVM. Increased UA PI > 95th centile (OR 2.91, 95%CI 1.71, 4.95, p=<0.001) and mean UtA PI z-score (OR 1.74, 95% CI 1.15, 2.64, p = 0.01) were associated with higher odds of MVM. Rates of severe non-neurological morbidity were highest in the MVM, FVM, and CHI cohorts (44.8 %, 50 %, and 50 % respectively). Conclusion: MVM was the commonest placental abnormality in FGR, particularly in early-onset disease. Low maternal PlGF levels, high sFlt-1 levels, elevated sFlt-1/PlGF ratio, and abnormal fetoplacental Dopplers were also significantly associated with MVM. MVM, FVM, and CHI abnormalities were associated with lower median birthweight, higher rates of preterm birth, operative birth for non-reassuring fetal status, and severe neonatal non-neurological morbidity.
dc.description.statementofresponsibilityJesrine Hong, Kylie Crawford, Matthew Daly, Vicki Clifton, Fabricio da Silva Costa, Anthony V. Perkins, Admire Matsika, Rohan Lourie, Sailesh Kumar
dc.identifier.citationPlacenta, 2024; 156:20-29
dc.identifier.doi10.1016/j.placenta.2024.08.016
dc.identifier.issn0143-4004
dc.identifier.issn0143-4004
dc.identifier.orcidClifton, V. [0000-0002-4892-6748]
dc.identifier.urihttps://hdl.handle.net/2440/143834
dc.language.isoen
dc.publisherElsevier
dc.relation.grantNHMRC
dc.rights© 2024 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
dc.source.urihttps://doi.org/10.1016/j.placenta.2024.08.016
dc.subjectFetal growth restriction
dc.subjectMaternal vascular malperfusion
dc.subjectPlacental dysfunction
dc.subjectPlacental growth factor
dc.subjectPlacental pathology
dc.subjectPregnancy
dc.subjectSoluble-fms like tyrosine kinase-1
dc.subject.meshPlacenta
dc.subject.meshHumans
dc.subject.meshFetal Growth Retardation
dc.subject.meshVascular Endothelial Growth Factor Receptor-1
dc.subject.meshUltrasonography, Doppler
dc.subject.meshUltrasonography, Prenatal
dc.subject.meshProspective Studies
dc.subject.meshPregnancy
dc.subject.meshAdult
dc.subject.meshFemale
dc.subject.meshBiomarkers
dc.subject.meshPlacenta Growth Factor
dc.titleUtility of placental biomarkers and fetoplacental Dopplers in predicting likely placental pathology in early and late fetal growth restriction – A prospective study
dc.typeJournal article
pubs.publication-statusPublished

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