Kosińska-Kaczyńska Katarzyna, Chaberek Katarzyna, Szymecka-Samaha Natalia, Czapska Agnieszka, Żebrowska Kinga, Dera Norbert, Modzelewski Jan, Góra Jakub, Borawski Kacper, Włoch Weronika, Scholz Anna, Biskupski-Samaha Robert Brawura-
Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Warsaw, Poland.
1st Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland.
J Matern Fetal Neonatal Med. 2025 Dec;38(1):2456983. doi: 10.1080/14767058.2025.2456983. Epub 2025 Jan 29.
Small-for-gestational age (SGA) newborns are at increased risk of adverse neonatal outcomes and the risk is related to the etiology of growth restriction: highest in placental insufficiency, lowest in constitutional SGA. The aim of this study was to investigate if placental growth factor (PlGF), soluble fms-like tyrosine kinase-1(sFlt-1) or sFlt-1/PlGF ratio are efficient in prediction of adverse neonatal outcomes in SGA newborns delivered ≥34 weeks of gestation.
A prospective observational multicenter cohort study was performed. Women in singleton gestation had serum PlGF, sFlt-1 and sFlt-1/PlGF ratio measured at the time of SGA diagnosis and included if they delivered ≥34 weeks. The primary outcome was adverse neonatal outcome, diagnosed in case of any of the following: Neonatal Intensive Care Unit hospitalization, mechanical ventilation, continuous positive airway pressure, sepsis, necrotizing enterocolitis, intraventricular hemorrhage grade III or IV and neonatal death before discharge. The Mann-Whitney test and the Fisher's exact test were used for the statistical analysis. Cutoff points for adverse outcome prediction were calculated based on ROC curves. Multivariate logistic regression analysis was performed to adjust for confounding factors.
A total of 102 women were included in the study. Serum PlGF concentration of 137 pg/mL had a sensitivity of 75% (95% CI 58.8 - 87.3), specificity of 56.45% (95% CI 43.3 - 69.0), positive likelihood ratio of 1.72 (95% CI 1.23 - 2.41) and negative likelihood ratio of 0.44 (95% CI 0.25 - 0.79) in prediction of adverse outcomes. Serum sFlt-1 level of 2018 pg/mL had a sensitivity of 82.05% (95% CI 66.5 - 92.5), specificity of 50% (95% CI 37.0 - 63.0), positive likelihood ratio of 1.64 (95% CI 1.23 - 2.19) and negative likelihood ratio of 0.36 (95% CI 0.18 - 0.73), while sFlt-1/PlGF ratio of 18.9 had a sensitivity of 79.92% (95% CI 60.7 - 88.9), specificity of 56.45% (95% CI 43.3 - 69.0), positive likelihood ratio of 1.77 (95% CI 1.27 - 2.46) and negative likelihood ratio of 0.41 (95% CI 0.22 - 0.75) in prediction of adverse outcomes. In logistic regression analysis only birth weight was an independent risk factors for adverse outcome.
In pregnancies with SGA, fetuses measurements of maternal serum sFlt-1 or PlGF provide poor prediction of adverse neonatal outcomes.
小于胎龄（SGA）新生儿出现不良新生儿结局的风险增加，且该风险与生长受限的病因相关：胎盘功能不全时风险最高，体质性SGA时风险最低。本研究的目的是调查胎盘生长因子（PlGF）、可溶性fms样酪氨酸激酶-1（sFlt-1）或sFlt-1/PlGF比值是否能有效预测妊娠≥34周分娩的SGA新生儿的不良新生儿结局。
进行了一项前瞻性观察性多中心队列研究。单胎妊娠女性在SGA诊断时测定血清PlGF、sFlt-1和sFlt-1/PlGF比值，若她们妊娠≥34周分娩则纳入研究。主要结局为不良新生儿结局，在出现以下任何一种情况时诊断：新生儿重症监护病房住院、机械通气、持续气道正压通气、败血症、坏死性小肠结肠炎、III级或IV级脑室内出血以及出院前新生儿死亡。采用曼-惠特尼检验和费舍尔精确检验进行统计分析。根据ROC曲线计算不良结局预测的截断点。进行多变量逻辑回归分析以调整混杂因素。
共有102名女性纳入研究。血清PlGF浓度为137 pg/mL时，预测不良结局的灵敏度为75%（95%CI 58.8 - 87.3），特异度为56.45%（95%CI 43.3 - 69.0），阳性似然比为1.72（95%CI 1.23 - 2.41），阴性似然比为0.44（95%CI 0.25 - 0.79）。血清sFlt-1水平为2018 pg/mL时，灵敏度为82.05%（95%CI 66.5 - 92.5），特异度为50%（95%CI 37.0 - 63.0），阳性似然比为1.64（95%CI 1.23 - 2.19），阴性似然比为0.36（95%CI 0.18 - 0.73），而sFlt-1/PlGF比值为18.9时，预测不良结局的灵敏度为79.92%（95%CI 60.7 - 88.9），特异度为56.45%（95%CI 43.3 - 69.0），阳性似然比为1.77（95%CI 1.27 - 2.46），阴性似然比为0.41（95%CI 0.22 - 0.75）。在逻辑回归分析中，只有出生体重是不良结局的独立危险因素。
在SGA妊娠中，检测孕妇血清sFlt-1或PlGF对胎儿不良新生儿结局的预测效果不佳。
