Anderson Ngaire, De Laat Monique, Benton Samantha, von Dadelszen Peter, McCowan Lesley
Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand.
Maternal Fetal Medicine Specialist, National Women's Hospital, Auckland District Health Board, Auckland, New Zealand.
Aust N Z J Obstet Gynaecol. 2019 Feb;59(1):89-95. doi: 10.1111/ajo.12831. Epub 2018 May 31.
At-risk small-for-gestational age (SGA) pregnancies in New Zealand are identified using Doppler ultrasound; fetuses with Doppler abnormalities are considered growth restricted (FGR). Low maternal placental growth factor (PlGF) has also been associated with late-onset FGR.
To investigate whether low PlGF at diagnosis of late-onset SGA identifies the same fetuses classified FGR by detailed Doppler studies, and the association between low PlGF and adverse pregnancy outcomes.
Among an historical database of normotensive suspected SGA pregnancies (fetal abdominal circumference <10th percentile) ≥32 weeks gestation, the ability of low PlGF (<5th percentile) to identify FGR infants was investigated. 'Initial FGR' was an abnormal umbilical artery resistance index (RI) or estimated fetal weight <3rd customised centile. 'Secondary FGR' was abnormal internal carotid RI, cerebro-placental ratio and/or mean uterine artery RI. Development of hypertensive disease and adverse perinatal outcomes were compared by PlGF status.
Of 136 SGA pregnancies, 56 (41.1%) had initial FGR. Of the remaining, 20 (25.0%) had secondary FGR, 17 (21.3%) low PlGF. The sensitivity of low PlGF identifying secondary FGR was 0.30 (95% CI 0.14-0.50), specificity 0.83 (0.70-0.92), positive predictive value 0.47 (0.23-0.72) and negative predictive value 0.70 (0.57-0.81). Overall, low PlGF occurred in 44/136 (32.4%) pregnancies and was associated with gestational hypertensive disease (63.6% vs 15.2%, P < 0.01), adverse perinatal outcome (34.1% vs 15.2%, P = 0.01) and very low birthweight (customised centile 2.2 vs 6.8, P < 0.01).
At diagnosis of late-onset SGA, low PlGF was poor at identifying Doppler-defined FGR. Low PlGF identified pregnancies at risk of hypertensive disease, adverse perinatal outcome and very low birthweight.
在新西兰，通过多普勒超声来识别有风险的小于胎龄儿（SGA）妊娠；多普勒异常的胎儿被视为生长受限（FGR）。母体胎盘生长因子（PlGF）水平低也与晚发型FGR有关。
研究晚发型SGA诊断时PlGF水平低是否能识别出经详细多普勒研究分类为FGR的相同胎儿，以及PlGF水平低与不良妊娠结局之间的关联。
在一个妊娠≥32周的血压正常的疑似SGA妊娠（胎儿腹围<第10百分位数）的历史数据库中，研究PlGF水平低（<第5百分位数）识别FGR婴儿的能力。“初始FGR”是脐动脉阻力指数（RI）异常或估计胎儿体重<第3定制百分位数。“继发性FGR”是颈内动脉RI、脑胎盘比和/或子宫动脉平均RI异常。根据PlGF状态比较高血压疾病的发生情况和不良围产期结局。
在136例SGA妊娠中，56例（41.1%）有初始FGR。其余病例中，20例（25.0%）有继发性FGR，17例（21.3%）PlGF水平低。PlGF水平低识别继发性FGR的敏感性为0.30（95%CI 0.14 - 0.50），特异性为0.83（0.70 - 0.92），阳性预测值为0.47（0.23 - 0.72），阴性预测值为0.70（0.57 - 0.81）。总体而言，44/136例（32.4%）妊娠出现PlGF水平低，且与妊娠期高血压疾病（63.6%对15.2%，P<0.01）、不良围产期结局（34.1%对15.2%，P = 0.01）和极低出生体重（定制百分位数2.2对6.8，P<0.01）相关。
在晚发型SGA诊断时，PlGF水平低在识别多普勒定义的FGR方面效果不佳。PlGF水平低可识别出有高血压疾病、不良围产期结局和极低出生体重风险的妊娠。
