Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small‐for‐gestational‐age infant in women presenting with reduced symphysis–fundus height

Abstract

ObjectivesTo assess the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters to predict delivery of a small‐for‐gestational‐age (SGA) infant in women presenting with reduced symphysis–fundus height (SFH).MethodsThis was a multicenter prospective observational study recruiting 601 women with a singleton pregnancy and reduced SFH between 24 and 37 weeks' gestation across 11 sites in the UK and Canada. Plasma PlGF concentration < 5th centile, estimated fetal weight (EFW) < 10th centile, umbilical artery Doppler pulsatility index > 95th centile and oligohydramnios (amniotic fluid index < 5 cm) were compared as predictors for a SGA infant < 3rd customized birth‐weight centile and adverse perinatal outcome. Test performance statistics were calculated for all parameters in isolation and in combination.ResultsOf the 601 women recruited, 592 were analyzed. For predicting delivery of SGA < 3rd centile (n = 78), EFW < 10th centile had 58% sensitivity (95% CI, 46–69%) and 93% negative predictive value (NPV) (95% CI, 90–95%), PlGF had 37% sensitivity (95% CI, 27–49%) and 90% NPV (95% CI, 87–93%); in combination, PlGF and EFW < 10th centile had 69% sensitivity (95% CI, 55–81%) and 93% NPV (95% CI, 89–96%). The equivalent receiver–operating characteristics (ROC) curve areas were 0.79 (95% CI, 0.74–0.84) for EFW < 10th centile, 0.70 (95% CI, 0.63–0.77) for low PlGF and 0.82 (95% CI, 0.77–0.86) in combination.ConclusionsFor women presenting with reduced SFH, ultrasound parameters had modest test performance for predicting delivery of SGA < 3rd centile. PlGF performed no better than EFW < 10th centile in determining delivery of a SGA infant. © 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the international society of ultrasound in obstetrics and gynecology.

Screening Performance of Placental Growth Factor for the Prediction of Low Birth Weight and Adverse Intrapartum and Neonatal Outcomes in a Term Low-Risk Population

“…However, maternal PlGF performs poorly as a predictor of LBW, emergency CS-IFC and adverse neonatal outcome in this population. Our results are in contrast to recent more promising reports of the screening performance of PlGF to detect LBW infants, where sensitivities have ranged from 30 to 98.2% and AUROC curves have ranged from 0.63 to 0.96 [8,[16][17][18]. The key difference between our study and previous studies is that in other studies maternal PlGF levels were measured in preterm cohorts, which naturally have a relatively higher prevalence of SGA or growth-restricted fetuses.…”

Predicting delivery of a small‐for‐gestational‐age infant and adverse perinatal outcome in women with suspected pre‐eclampsia

“…Ultrasound has an essential role in the detection of falling growth velocity, oligohydramnios and abnormal umbilical artery Doppler waveforms, which will continue to be used to stratify surveillance and time delivery appropriately. The use of PlGF for the prediction of SGA relates to this high‐risk group of women with suspected PE and cannot be generalized to low‐risk healthy pregnant women.…”

Comparison of three commercially available placental growth factor‐based tests in women with suspected preterm pre‐eclampsia: the COMPARE study

“…We conducted a retrospective analysis of samples collected as part of three prospective pregnancy cohorts (PEACHES, PELICAN‐1 and PELICAN‐2). Women were eligible for inclusion in this study if they presented with suspected preterm pre‐eclampsia or suspected fetal growth restriction before 37 weeks' gestation and when there were at least three sample aliquots available to allow measurement using each of the three tests being analyzed: DELFIA Xpress PlGF 1‐2‐3 test; Triage PlGF test; and Elecsys immunoassay sFlt‐1/PlGF ratio.…”

“…The PELICAN (plasma placental growth factor in the diagnosis of women with pre‐eclampsia requiring delivery within 14 days) studies were prospective multicenter observational studies undertaken between January 2011 and February 2012 in seven consultant‐led maternity units in the UK and Ireland (PELICAN‐1 study) and between December 2011 and July 2013 in 11 sites in the UK (PELICAN‐2 study). Women were eligible for inclusion if they presented with, or were referred with, symptoms or signs of suspected pre‐eclampsia or with reduced symphysis–fundus height and were ≥ 16 years of age.…”