Placental Growth Factor Associated with Perinatal Outcomes: An Urban-Rural Analysis in Western Canada.

OBJECTIVES

This study aimed to evaluate the association between low placental growth factor (PlGF) levels and adverse maternal and neonatal outcomes, and to assess whether rural residence modifies these associations in a high-risk obstetric population.

METHODS

A retrospective cohort study was conducted, including 189 high-risk pregnant persons who underwent second-trimester PlGF testing between December 2021 and December 2025. PlGF was categorized as low (<10th centile) or normal (≥10th centile). Outcomes included preeclampsia, preterm birth, low birthweight, small for gestational age, and neonatal intensive care unit (NICU) admission. Multivariable logistic regression models were used to estimate adjusted odds ratios. Rural residence was included as an exposure of interest in all models, and interaction terms between low PlGF level and rural residence were assessed to evaluate effect modification.

RESULTS

Low PlGF level was strongly associated with increased odds of preeclampsia, preterm birth, and low birthweight. No association was observed with small for gestational age. Rural residence did not modify the relationship between PlGF level and adverse outcomes. An initial interaction between PlGF and rural residence was observed for NICU admission; however, this interaction was attenuated and no longer statistically significant after adjustment for gestational age. Gestational age was a strong independent predictor of NICU admission.

CONCLUSIONS

Low PlGF level is a robust marker of placental dysfunction and is strongly associated with adverse perinatal outcomes across both rural and urban populations. While rural residence influences baseline risk, it does not modify the biological effect of PlGF. These findings support the clinical utility of PlGF for risk stratification across diverse geographic settings.