sFlt-1/PlGF and Doppler ultrasound parameters in SGA pregnancies with confirmed neonatal birth weight below 10th percentile

Kwiatkowski, Sebastian; Bednarek-Jędrzejek, Magdalena; Ksel, Joanna; Tousty, Piotr; Kwiatkowska, Ewa; Cymbaluk, Aneta; Rzepka, Rafał; Chudecka‐Głaz, Anita; Dołęgowska, Barbara; Torbé, Andrzej

doi:10.1016/j.preghy.2018.08.448

Cited by 22 publications

(15 citation statements)

References 21 publications

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“…When focusing on early third trimester, we found that pregnancies with SGA neonates had lower EFW and PlGF and higher values of mean UtA PI, sFlt-1 and sFlt-1/PlGF. This is in agreement with several reports that have provided evidence that angiogenic factors are different in late events [11,12,[31][32][33][34]. However, while both biochemical markers showed significantly different concentrations between SGA and normally growing fetuses, PlGF was the only biochemical marker included in the model.…”

Section: Comparison With Previous Studiessupporting

confidence: 92%

“Screening for small-for-gestational age neonates at early third trimester in a high-risk population for preeclampsia”

Mula

Meler

García

et al. 2020

BMC Pregnancy Childbirth

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Background Strategies to improve prenatal detection of small-for-gestational age (SGA) neonates are necessary because its association with poorer perinatal outcome. This study evaluated, in pregnancies with first trimester high risk of early preeclampsia, the performance of a third trimester screening for SGA combining biophysical and biochemical markers. Methods This is a prospective longitudinal study on 378 singleton pregnancies identified at high risk of early preeclampsia according to a first trimester multiparametric algorithm with the cutoff corresponding to 15% false positive rate. This cohort included 50 cases that delivered SGA neonates with birthweight < 10th centile (13.2%) and 328 cases with normal birthweight (86.8%). At 27–30 weeks’ gestation, maternal weight, blood pressure, estimated fetal weight, mean uterine artery pulsatility index and maternal biochemical markers (placental growth factor and soluble FMS-Like Tyrosine Kinase-1) were assessed. Different predictive models were created to evaluate their performance to predict SGA neonates. Results For a 15% FPR, a model that combines maternal characteristics, estimated fetal weight, mean uterine artery pulsatility index and placental growth factor achieved a detection rate (DR) of 56% with a negative predictive value of 92.2%. The area under receiver operating characteristic curve (AUC) was 0.79 (95% confidence interval (CI), 0.72–0.86). The DR of a model including maternal characteristics, estimated fetal weight and mean uterine artery pulsatility index was 54% (AUC, 0.77 (95% CI, 0.70–0.84)). The DR of a model that includes maternal characteristics and placental growth factor achieved a similar performance (DR 56%, AUC 0.75, 95% CI (0.67–0.83)). Conclusions The performance of screening for SGA neonates at early third trimester combining biophysical and biochemical markers in a high-risk population is poor. However, a high negative predictive value could help in reducing maternal anxiety, avoid iatrogenic interventions and propose a specific plan for higher risk patients.

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Section: Comparison With Previous Studiessupporting

confidence: 92%

“Screening for small-for-gestational age neonates at early third trimester in a high-risk population for preeclampsia”

Mula

Meler

García

et al. 2020

BMC Pregnancy Childbirth

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“…The soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio has been proposed as a short-term predictor to rule out pre-eclampsia in women in whom this condition is suspected clinically 33 . Although some reports suggest that use of the sFlt-1/PlGF ratio might be helpful in the management of and differentiation between SGA and FGR [34][35][36][37][38] , the lack of interventional trial data precludes the recommendation of these tests as an adjunct to ultrasound imaging. The rapidly evolving research-based discussion of the use of biomarkers in screening for SGA and FGR is beyond the scope of this Guideline.…”

Section: Biomarkersmentioning

confidence: 99%

“…Early FGR is particularly associated with maternal vascular malperfusion of the placenta, characterized by abnormal transformation of the spiral arteries, pathologic features of the placental villi and multifocal infarction; these disease components result in so-called 'placental insufficiency' and form the most common basis for placenta-mediated FGR 53,54 . Chronic ischemia of the placental villi impairs PlGF secretion and leads to excessive sFlt-1 release by syncytial knots, thus resulting in elevated sFlt-1/PlGF ratio which typifies early FGR and the associated hypertensive disorders of pregnancy [34][35][36][37][38] . Elevated Doppler UA-PI typically precedes a cascade of Doppler alterations, fetal heart rate changes and BPP modifications, with end-stage cardiovascular deterioration caused by severe hypoxemia followed by acidosis [55][56][57] .…”

Section: Early-onset Fetal Growth Restrictionmentioning

confidence: 99%

ISUOG Practice Guidelines: diagnosis and management of small‐for‐gestational‐age fetus and fetal growth restriction

Lees

Stampalija

Baschat

et al. 2020

Ultrasound in Obstet & Gyne

457

454

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ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction Clinical Standards CommitteeThe International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, and high-quality teaching and research related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care, because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (

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“…PlGF has consistently lower levels in SGA pregnancies, in 2 nd and 3 rd trimesters [82–84], especially for BW < 5 th or <10 th centiles. For higher sFlt-1/PlGF ratios, there is better AUC for preeclampsia-associated SGA [40, 41].…”

Section: When and How We Should Screen For Fetal Growth Restriction?mentioning

confidence: 99%

Fetal Growth Restriction Prediction: How to Move beyond

Leite

Cecatti

2019

The Scientific World Journal

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The actual burden and future burden of the small-for-gestational-age (SGA) babies turn their screening in pregnancy a question of major concern for clinicians and policymakers. Half of stillbirths are due to growth restriction in utero, and possibly, a quarter of livebirths of low- and middle-income countries are SGA. Growing body of evidence shows their higher risk of adverse outcomes at any period of life, including increased rates of neurologic delay, noncommunicable chronic diseases (central obesity and metabolic syndrome), and mortality. Although there is no consensus regarding its definition, birthweight centile threshold, or follow-up, we believe birthweight <10th centile is the most suitable cutoff for clinical and epidemiological purposes. Maternal clinical factors have modest predictive accuracy; being born SGA appears to be of transgenerational heredity. Addition of ultrasound parameters improves prediction models, especially using estimated fetal weight and abdominal circumference in the 3rd trimester of pregnancy. Placental growth factor levels are decreased in SGA pregnancies, and it is the most promising biomarker in differentiating angiogenesis-related SGA from other causes. Unfortunately, however, only few societies recommend universal screening. SGA evaluation is the first step of a multidimensional approach, which includes adequate management and long-term follow-up of these newborns. Apart from only meliorating perinatal outcomes, we hypothesize SGA screening is a key for socioeconomic progress.

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sFlt-1/PlGF and Doppler ultrasound parameters in SGA pregnancies with confirmed neonatal birth weight below 10th percentile

Cited by 22 publications

References 21 publications

“Screening for small-for-gestational age neonates at early third trimester in a high-risk population for preeclampsia”

“Screening for small-for-gestational age neonates at early third trimester in a high-risk population for preeclampsia”

ISUOG Practice Guidelines: diagnosis and management of small‐for‐gestational‐age fetus and fetal growth restriction

Fetal Growth Restriction Prediction: How to Move beyond

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