Institute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
Fetal Medicine Research Institute, King's College Hospital, London, UK.
BJOG. 2024 May;131(6):803-810. doi: 10.1111/1471-0528.17684. Epub 2023 Oct 24.
To determine whether serum placental growth factor (PlGF) at 19-23 weeks of gestation can improve the identification of risk for adverse outcomes.
Prospective observational cohort study.
Two English maternity units.
Unselected singleton pregnancies attending routine ultrasound at 19-23 weeks of gestation.
Outcomes ascertained by health record review. Diagnostic test properties evaluated clinical risk factors for pre-eclampsia (according to National Institute of Care Excellence) or fetal growth restriction (according to Royal College of Obstetricians and Gynaecologists), low PlGF at 19-23 weeks of gestation (<5th percentile) or both.
Pre-eclampsia, gestational hypertension, stillbirth, birthweight below third percentile or neonatal intensive care unit (NICU) admission for ≥48 h.
In 30 013 pregnancies, risk factors were present in 9941 (33.1%), low PlGF was present in 1501 (5.0%) and both ('two-stage' screening) were present in 547 (1.8%) pregnancies. Risk factors detected 41.7%-54.7% of adverse outcomes, and could not meaningfully revise the risk (all positive likelihood ratios, +LR, <5.0; all negative likelihood ratios, -LR, ≥0.2). Low PlGF detected 8.5%-17.4% of adverse outcomes, but meaningfully increased risks (other than NICU admission) associated with delivery <37 weeks of gestation (+LR = 5.03-15.55); all -LRs were ≥0.2. 'Two-stage' screening detected 4.2%-8.9% of adverse outcomes, with meaningful +LRs (6.28-18.61) at <37 weeks of gestation, except for NICU admission of ≥48 h, which had an +LR of 7.56 at <34 weeks of gestation; all -LRs were ≥0.2. No screening strategy meaningfully increased or decreased the detection of adverse outcome risk at term.
Clinical risk factor screening has a high screen-positive rate and a poor detection of adverse outcomes. False positives cannot be reduced by PlGF testing at 19-23 weeks of gestation; therefore, this cannot be recommended as a useful strategy on its own.
确定妊娠 19-23 周时血清胎盘生长因子（PlGF）是否能提高不良结局的风险识别能力。
前瞻性观察队列研究。
英国的两家产科单位。
在妊娠 19-23 周进行常规超声检查的未选择的单胎妊娠。
通过健康记录回顾确定结局。评估临床风险因素（根据国家保健卓越研究所）或胎儿生长受限（根据皇家妇产科医师学院）、妊娠 19-23 周时 PlGF 水平低（<第 5 百分位数）或两者的诊断试验特性。
子痫前期、妊娠高血压、死胎、出生体重低于第 3 百分位数或新生儿重症监护病房（NICU）入住≥48 小时。
在 30013 例妊娠中，9941 例（33.1%）存在风险因素，1501 例（5.0%）存在 PlGF 水平低，547 例（1.8%）存在“两阶段”筛查。风险因素检测到 41.7%-54.7%的不良结局，且无法显著改变风险（所有阳性似然比，+LR，<5.0；所有阴性似然比，-LR，≥0.2）。低 PlGF 检测到 8.5%-17.4%的不良结局，但显著增加了与妊娠<37 周相关的风险（除了 NICU 入住≥48 小时）（+LR=5.03-15.55）；所有 -LR 均≥0.2。“两阶段”筛查检测到 4.2%-8.9%的不良结局，妊娠<37 周时具有显著的+LR（6.28-18.61），但 NICU 入住≥48 小时除外，其在妊娠<34 周时的+LR 为 7.56；所有 -LR 均≥0.2。没有筛查策略能显著增加或降低足月时不良结局风险的检出率。
临床风险因素筛查的阳性率高，对不良结局的检出率低。PlGF 检测不能减少假阳性，因此，单独使用这种方法不能作为一种有用的策略。
