Usefulness of angiogenic factors in prenatal counseling of late-onset fetal growth-restricted and small-for-gestational-age gestations: a prospective observational study

Objectives To create a predictive model including biomarkers and evaluate its ability to predict adverse perinatal outcomes in late-onset small fetuses, ultimately helping to provide individualized counseling at the time of diagnosis. Methods This was a prospective observational study, including sin...

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Published in:Archives of gynecology and obstetrics 2023-11, Vol.308 (5), p.1485-1495
Main Authors: Hurtado, Ivan, Bonacina, Erika, Garcia-Manau, Pablo, Serrano, Berta, Armengol-Alsina, Mireia, Mendoza, Manel, Maiz, Nerea, Carreras, Elena
Format: Article
Language:English
Subjects:
Counseling
Endocrinology
Gestational age
Gynecology
Human Genetics
Maternal-Fetal Medicine
Medicine
Medicine & Public Health
Observational studies
Obstetrics/Perinatology/Midwifery
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Summary:Objectives To create a predictive model including biomarkers and evaluate its ability to predict adverse perinatal outcomes in late-onset small fetuses, ultimately helping to provide individualized counseling at the time of diagnosis. Methods This was a prospective observational study, including singleton pregnancies with an estimated fetal weight (EFW) below the 10th percentile, at a gestational age between 32 + 0 and 36 + 6 weeks of gestation (WG). Variables recorded at diagnosis to predict adverse pregnancy outcomes were: soluble fms-like tyrosine-kinase-1 to placental growth factor ratio (sFlt-1/PlGF), fetal Doppler (umbilical artery and middle cerebral artery), uterine artery pulsatility index (UtAPI), EFW percentile, gestational age, and the presence of maternal risk factors for placental insufficiency. Logistic regression models were developed for the prediction of three co-primary outcomes: composite adverse perinatal outcomes (APO), and the need for elective delivery before 35 or 37 WG. Results Sixty (52.2%) fetal growth restricted (FGR) and 55 (47.8%) small for gestational age (SGA) were enrolled. Thirteen (11.3%) women needed elective delivery before 35 WG and 27 (23.5%) women before 37 WG. At least one APO occurred in 43 (37.4%) pregnancies. The best marker in univariate analyses was the sFlt-1/PlGF ratio [AUC = 0.932 (95% CI, 0.864–0.999)]. The multivariate model including sFlt-1/PlGF showed a better predictive performance for APO than the multivariate model without sFlt-1/PlGF ( P  
ISSN:1432-0711
0932-0067
1432-0711
DOI:10.1007/s00404-022-06833-5