Low molecular weight heparin (LMWH) therapy guided by low placental growth factor (PlGF) in a diabetes-prevalent population: preliminary retrospective cohort.

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.