Placental Growth Factor and Compromised Fetal Growth: Associations with Placental Ultrasound Morphology and Pathology in a Retrospective Cohort Study.

OBJECTIVES

Fetal growth restriction (FGR) is often associated with placental dysfunction. Circulating placental growth factor (PlGF) is a promising biomarker for identifying pregnancies at risk of placental disease and FGR. This study evaluated how maternal PlGF levels relate to fetal growth and adverse perinatal outcomes, and how compromised growth relates to placental morphology/pathology and perinatal outcomes.

METHODS

Retrospective cohort of 305 patients. Maternal PlGF levels were measured as the primary exposure. The primary outcome was compromised fetal growth (FGR/small for gestational age versus normal growth) defined by Delphi criteria. Secondary outcomes included abnormal sonographic placental morphology, placental pathology demonstrating maternal or fetal vascular malperfusion, preeclampsia, intrauterine fetal demise, preterm birth <34 weeks, birthweight <third percentile, and neonatal intensive care unit admission.

RESULTS

Low PlGF was strongly associated with compromised fetal growth (OR 4.6; 95% CI 2.7-7.8, P < 0.0001). Compromised fetal growth was associated with abnormal placental morphology (OR 4.2; 95% CI 2.5-7.2), maternal/fetal vascular malperfusion on pathology (OR 15.5; 95% CI 5.2-46.3) and adverse perinatal outcomes, including intrauterine fetal demise, preterm birth <34 weeks, birthweight <third percentile, and neonatal intensive care unit admission. Differences in gestational age at first visit and delivery were significant across growth categories (P < 0.0001).

CONCLUSIONS

Low PlGF levels and abnormal placental morphology are strong indicators of placental dysfunction and FGR, even when independent of preeclampsia. Incorporating PlGF testing into high-risk pregnancies' management may enable earlier identification of compromised growth and improve obstetric outcomes, particularly in settings with limited resources.