Triunfo S, Lobmaier S, Parra-Saavedra M, Crovetto F, Peguero A, Nadal A, Gratacos E, Figueras F
BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany.
Placenta. 2014 Jun;35(6):398-403. doi: 10.1016/j.placenta.2014.03.021. Epub 2014 Apr 5.
This study was designed to explore the association between angiogenic factors levels at diagnosis of small-for-gestational age (SGA) and placental underperfusion (PUP).
In a cohort of SGA singleton pregnancies, each delivered at >34 weeks, uterine (UtA), umbilical (UA), and middle cerebral (MCA) arteries were evaluated by Doppler upon diagnosis of SGA status. In addition, maternal circulating concentrations of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were assayed by ELISA, and each placenta was evaluated for histologic signs of PUP using a hierarchical and standardized classification system. Logistic regression was applied to analyze independent relationships (at diagnosis) between angiogenic factors and Doppler parameters.
A total of 122 suspected SGA pregnancies were studied, 70 (57.4%) of which ultimately met PUP criteria. In this group, 85 placental findings qualified as PUP. Both mean UtA pulsatility index z-values (1.26 vs. 0.84; p = 0.038) and PlGF multiples of normal median (0.21 vs. 0.55; p = 0.002) differed significantly in pregnancies with and without PUP, respectively. By logistic regression, PlGF alone was independently predictive of PUP (OR = 0.11 [95% CI 0.025-0.57]; p = 0.008).
Histologic placental abnormalities in term SGA neonates reflect latent insufficiency in uteroplacental blood supply. The heightened risk of adverse perinatal outcomes in this context underscores a need for new Doppler or biochemical prenatal markers of placental disease. Angiogenic factors may be pivotal identifying SGA neonates.
Diminished circulating levels of placental growth factor, determined upon discovery of SGA status, are associated with histologic evidence of PUP.
本研究旨在探讨小于胎龄儿（SGA）诊断时血管生成因子水平与胎盘灌注不足（PUP）之间的关联。
在一组孕周>34周分娩的SGA单胎妊娠队列中，诊断SGA状态时通过多普勒评估子宫动脉（UtA）、脐动脉（UA）和大脑中动脉（MCA）。此外，采用酶联免疫吸附测定法（ELISA）检测母体循环中胎盘生长因子（PlGF）和可溶性fms样酪氨酸激酶-1（sFlt-1）的浓度，并使用分级标准化分类系统对每个胎盘进行PUP组织学征象评估。应用逻辑回归分析血管生成因子与多普勒参数之间的独立关系（诊断时）。
共研究了122例疑似SGA妊娠，其中70例（57.4%）最终符合PUP标准。在该组中，85个胎盘检查结果符合PUP。有PUP和无PUP的妊娠中，UtA搏动指数z值均值（分别为1.26对0.84；p = 0.038）和PlGF相对于正常中位数的倍数（分别为0.21对0.55；p = 0.002）均有显著差异。通过逻辑回归分析，单独的PlGF可独立预测PUP（比值比[OR]=0.11[95%置信区间0.025 - 0.57]；p = 0.008）。
足月SGA新生儿的胎盘组织学异常反映了子宫胎盘血液供应的潜在不足。在此背景下围产儿不良结局风险增加，凸显了对胎盘疾病新的多普勒或生化产前标志物的需求。血管生成因子可能是识别SGA新生儿的关键因素。
在发现SGA状态时测定的胎盘生长因子循环水平降低与PUP的组织学证据相关。
