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Ultrasound in Obstet Gyne - 2025 - Hong - Placental biomarker and fetoplacental Doppler abnormalities are strongly366.46 kB
Published VersionCC BY V4.0, Open Access
Journal article
Placental biomarker and fetoplacental Doppler abnormalities are strongly associated with placental pathology in pregnancies with small-for-gestational-age fetus: prospective study
Ultrasound in Obstetrics and Gynecology, Vol.65(6), pp.749-760
2025
PMID: 40329845
Abstract
Objective
Placental dysfunction can result in small-for-gestational age (SGA) or fetal growth restriction (FGR). The aim of this prospective cohort study was to assess the association of the cerebroplacental ratio (CPR) and other more conventional fetoplacental Doppler indices, circulating placental growth factor (PlGF) levels and soluble fms-like tyrosine kinase-1 (sFlt-1)/PlGF ratio, with specific placental abnormalities in a large cohort of pregnancies with an SGA/FGR fetus.
Methods
This was a prospective cohort study of singleton pregnancies with a SGA/FGR fetus conducted at the Centre for Maternal and Fetal Medicine at the Mater Mother's Hospital, Queensland, Australia. Multivariable logistic regression with adjustment for pre-eclampsia was used to evaluate the effect of CPR < 5th centile, umbilical artery Doppler abnormality (defined as umbilical artery (UA) pulsatility index (PI) > 95th centile, or absent or reversed end-diastolic flow), mean uterine artery (UtA) PI > 95th centile and abnormal placental biomarkers (PlGF level < 100 ng/L and sFlt-1/PlGF ratio > 5.78 if gestational age < 28 weeks or > 38 if gestational age ≥ 28 weeks) on the following placental abnormalities, classified based on the Amsterdam Placental Workshop Group Consensus criteria: placental maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), villitis of unknown etiology (VUE), chronic histiocytic intervillositis (CHI) and delayed villous maturation (DVM).
Results
Among the 367 women included in this study, MVM was present in 159 (43.3%) placentae, FVM in 20 (5.4%), VUE in 49 (13.4%), DVM in 19 (5.2%) and CHI in six (1.6%). Compared to SGA controls with normal fetoplacental Doppler and placental biomarkers, CPR < 5th centile (adjusted odds ratio (aOR), 3.17 (95% CI, 1.95–5.16); P < 0.001), abnormal UA Doppler (aOR, 2.97 (95% CI, 1.80–4.90); P < 0.001) and mean UtA-PI > 95th centile (aOR, 5.42 (95% CI 2.75–10.70); P < 0.001) were associated with higher odds of placental abnormality. The odds of MVM specifically were significantly higher when CPR < 5th centile (aOR, 2.47 (95% CI, 1.64–4.33); P < 0.001), abnormal UA Doppler (aOR, 3.13 (95% CI, 1.91–5.12); P < 0.001) or mean UtA-PI > 95th centile (aOR, 4.01 (95% CI, 2.25–7.13); P < 0.001) was present. The odds of placental abnormality were also significantly higher if PlGF levels were < 100 ng/L (aOR, 3.66 (95% CI, 2.22–6.06); P < 0.001) or the sFlt-1/PlGF ratio was elevated (aOR, 3.74 (95% CI, 2.17–6.43); P < 0.001). The odds of MVM were also higher in women with PlGF < 100 ng/L (aOR, 2.89 (95% CI, 1.72–4.85); P < 0.001) and elevated sFlt-1/PlGF ratio (aOR, 3.15 (95% CI, 1.83–5.45); P < 0.001).
Conclusion
In pregnancies with SGA/FGR fetus, mean UtA-PI > 95th centile, abnormal UA Doppler, CPR < 5th centile, PlGF < 100 ng/L and elevated sFlt-1/PlGF ratio were all strongly associated with placental abnormality, particularly MVM.
Details
- Title
- Placental biomarker and fetoplacental Doppler abnormalities are strongly associated with placental pathology in pregnancies with small-for-gestational-age fetus: prospective study
- Authors
- J Hong - The University of QueenslandK Crawford - The University of QueenslandE Cavanagh - The University of QueenslandV Clifton - Mater ResearchF da Silva Costa - Gold Coast HospitalA V Perkins - University of the Sunshine Coast, Queensland, School of HealthS Kumar (Corresponding Author) - The University of Queensland
- Publication details
- Ultrasound in Obstetrics and Gynecology, Vol.65(6), pp.749-760
- Publisher
- John Wiley & Sons Ltd.
- Date published
- 2025
- DOI
- 10.1002/uog.29237
- ISSN
- 1469-0705; 0960-7692
- PMID
- 40329845
- Copyright note
- © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Data Availability
- The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
- Grant note
- National Health and Medical Research Council; Mater Foundation
- Organisation Unit
- School of Health
- Language
- English
- Record Identifier
- 991128690302621
- Output Type
- Journal article
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- Domestic collaboration
- International collaboration
- Web Of Science research areas
- Acoustics
- Obstetrics & Gynecology
- Radiology, Nuclear Medicine & Medical Imaging
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