Pregnancy hypertension · 2026
Low molecular weight heparin (LMWH) therapy guided by low placental growth factor (PlGF) in a diabetes-prevalent population: preliminary retrospective cohort.
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Figueiro-Filho Ernesto A, Dietrich Genevieve M, Poulin Alysa, Souza Lira Adrielle P, Ramadan Eman, Adanlawo Adewumi, Goncalves Guedes Pedro Henrique, Mendes-Silva Ana Paula, Buse Joshua D
Аннотация
OBJECTIVES: Low placental growth factor (PlGF < 5th centile) is predictive of preeclampsia, fetal growth restriction (FGR) and preterm birth. In our region, diabetes during pregnancyincreasesthe risk of placental dysfunction. Preclinical and clinical studies suggest that low-molecular-weight heparin (LMWH) can increase PlGF levels. We assessed whether prophylactic LMWH was associated with improved outcomes in pregnancies with low PlGF within a diabetes-prevalent population.
STUDY DESIGN: Retrospective cohort of 471 singleton pregnancies tested for PlGF between Dec 2021-Jan 2025. PlGF was classified as normal (>10th centile) or low (<5th centile). Among the 149 low PlGF cases, 57 received LMWH (enoxaparin 40 mg daily) plus aspirin. Primary outcomes were fetal growth categories. Secondary outcomes included maternal metabolic/renal markers, ultrasound parameters, preeclampsia, gestational age at delivery, NICU admission, and placental pathology.
RESULTS: Diabetes was present in 43.6 % of low PlGF pregnancies. LMWH recipients had better third-trimester HbA1c, lower protein-creatinine ratio, more normal uterine Dopplers, improved placental morphology, and more term deliveries (40 % vs 11 %; p < 0.001; OR 5.5; NNT = 3). LMWH use was associated with fewer SGA births from 17.4 % to 5.3 % (p = 0.04; OR 0.26, NNT = 9) and increased normal growth (53 % vs 33 %; p = 0.01; OR 2.3, NNT = 5), although there was no difference in FGR or preeclampsia rates. Pathology revealed small placentas with minimal vascular malperfusion..
CONCLUSIONS: LMWH in low PlGF pregnancies, often complicated by diabetes, was associated with better glycemic control, improved placental function, and fewer SGA births. Findings support biomarker-guided trials of LMWH in thisgroup.
STUDY DESIGN: Retrospective cohort of 471 singleton pregnancies tested for PlGF between Dec 2021-Jan 2025. PlGF was classified as normal (>10th centile) or low (<5th centile). Among the 149 low PlGF cases, 57 received LMWH (enoxaparin 40 mg daily) plus aspirin. Primary outcomes were fetal growth categories. Secondary outcomes included maternal metabolic/renal markers, ultrasound parameters, preeclampsia, gestational age at delivery, NICU admission, and placental pathology.
RESULTS: Diabetes was present in 43.6 % of low PlGF pregnancies. LMWH recipients had better third-trimester HbA1c, lower protein-creatinine ratio, more normal uterine Dopplers, improved placental morphology, and more term deliveries (40 % vs 11 %; p < 0.001; OR 5.5; NNT = 3). LMWH use was associated with fewer SGA births from 17.4 % to 5.3 % (p = 0.04; OR 0.26, NNT = 9) and increased normal growth (53 % vs 33 %; p = 0.01; OR 2.3, NNT = 5), although there was no difference in FGR or preeclampsia rates. Pathology revealed small placentas with minimal vascular malperfusion..
CONCLUSIONS: LMWH in low PlGF pregnancies, often complicated by diabetes, was associated with better glycemic control, improved placental function, and fewer SGA births. Findings support biomarker-guided trials of LMWH in thisgroup.