OP01.08: Value of adding angiogenic factors to ultrasound Doppler criteria in the definition of fetal growth restriction
Year: 2024
Type: conference-abstract
Abstract: To investigate the added value of maternal angiogenic factors to ultrasound and Doppler criteria currently used for the classification of small fetuses as low-risk small-for-gestational-age (SGA) or high-risk fetal growth restriction (FGR). Singleton pregnancies (N = 602) with a diagnosis of fetal smallness (defined as estimated fetal weight (EFW) and birthweight < 10th centile) and a gestational age at delivery ≥34 weeks' gestation were prospectively recruited. Ultrasound assessment of EFW and Doppler [uterine arteries pulsatility index (UtA-PI) and cerebroplacental ratio (CPR)] was performed at diagnosis. Biochemical analysis of PlGF and sFlt-1 in peripheral maternal venous blood was measured by ELISA. The primary outcome was APO defined as a composite of perinatal death or metabolic acidosis (umbilical artery pH < 7) or emergency Caesarean section for fetal distress or neonatal unit admission. The predictive value of EFW < 3 centile, Doppler parameters (UtA-PI >95 centile and CPR < 5 centile) and sFlt-1/PlGF ratio >95 centile, alone or in combination was assessed by logistic regression. All parameters were independently associated with APO: EFW < 3rd centile [adjusted odds ratio 2.58 (1.67 – 4)], UtA-PI [aOR 1.92 (1.25 – 2.94)], CPR [aOR 2.35 (1.46 – 3.78)] and sFlt-1/PlGF [aOR 1.71 (1.09 – 2.69)]. The presence of pre-eclampsia was a significant modifier of these associations. The detection rate (DR) for APO of a combined model including EFW, UtA-PI and CPR was 86.8% with 62% false positives (FP). For a model including only sFlt1/PlGF the DR and FP were 39.8%% and 16.9% respectively whereas in combination with EFW the DR and FP were 81.3%% and 52.3% respectively. A model including all the parameters yielded a DR of 88.5% for a 64.5% of FP. Angiogenic factors as stand-alone criterion had a poor predictive value to identify high-risk FGR among late-onset small fetuses and it marginally improved the predictive value of currently used ultrasound-Doppler criteria.
DOI: 10.1002/uog.27881
Authors: L. Youssef, F. Crispi, S. Paolucci, J. Miranda, S.M. Lobmaier, F. Crovetto, F. Figueras, E. Gratacos
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4402361364