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The sFlt1/PlGF ratio predicts faster fetal deterioration in early fetal growth restriction

2023-05Artigo científico Acesso aberto
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dc.contributor.authorPalma dos Reis, Catarina R.
dc.contributor.authorBrás, Sofia
dc.contributor.authorMeneses, Tânia
dc.contributor.authorCerdeira, Ana S.
dc.contributor.authorVatish, Manu
dc.contributor.authorMartins, Ana T.
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblInforma Healthcare
dc.date.accessioned2023-04-04T22:18:42Z
dc.date.available2023-04-04T22:18:42Z
dc.date.issued2023-05
dc.descriptionFunding Information: Catarina R. Palma dos Reis acknowledges support from a Clarendon Fund Scholarship. Publisher Copyright: © 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
dc.description.abstractIntroduction: The velocity of fetal deterioration in fetal growth restriction is extremely variable, which makes monitoring and counseling very challenging. The soluble fms-like tyrosine kinase to placental growth factor (sFlt1/PlGF) ratio provides a readout of the vasoactive environment that correlates with preeclampsia and fetal growth restriction and that could be useful to predict fetal deterioration. Previous studies showed a correlation between higher sFlt1/PlGF ratios and lower gestational ages at birth, although it is unclear whether this is due to the increased incidence of preeclampsia. Our goal was to evaluate whether the sFlt1/PlGF ratio predicts faster fetal deterioration in early fetal growth restriction. Material and methods: This was a historical cohort study in a tertiary maternity hospital. Data from singleton pregnancies with early fetal growth restriction (diagnosed before 32 gestational weeks) confirmed after birth monitored between January 2016 and December 2020 were retrieved from clinical files. Cases of chromosomal/fetal abnormalities, infection and medical terminations of pregnancy were excluded. The sFlt1/PlGF ratio was acquired at diagnosis of early fetal growth restriction in our unit. The correlation of log10 sFlt1/PlGF with latency to delivery/fetal demise was assessed with linear, logistic (positive sFlt1/PlGF if >85) and Cox regression excluding deliveries for maternal conditions and controlling for preeclampsia, gestational age at time of ratio test, maternal age and smoking during pregnancy. Receiver-operating characteristic (ROC) analysis tested the performance of sFlt1/PlGF ratio in predicting delivery for fetal reasons in the following week. Results: 125 patients were included. Mean sFlt1/PlGF ratio was 91.2 (SD 148.7) and 28% of patients had a positive ratio. A higher log10 sFlt1/PlGF ratio predicted shorter latency for delivery/fetal demise in linear regression after controlling for confounders, β = −3.001, (−3.713 to −2.288). Logistic regression with ratio positivity confirmed these findings (latency for delivery 5.7 ± 3.32 weeks for ratios ≤85 vs 1.9 ± 1.52 weeks for ratios >85); β = −0.698 (−1.064 to −0.332). Adjusted Cox regression showed that a positive ratio confers a significantly positive hazard ratio (HR) for earlier delivery/fetal demise, HR 9.869 (5.061–19.243). ROC analysis showed an area under the curve of 0.847 (SE ± 0.06). Conclusions: sFlt1/PlGF ratio is correlated with faster fetal deterioration in early fetal growth restriction, independently of preeclampsia.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1221163
dc.identifier.doi10.1111/aogs.14546
dc.identifier.issn0001-6349
dc.identifier.otherPURE: 57556572
dc.identifier.otherPURE UUID: 40e524ab-f2c7-4fb6-96f0-ecb4ec7bb0c7
dc.identifier.otherScopus: 85150821379
dc.identifier.otherPubMed: 36933005
dc.identifier.urihttp://hdl.handle.net/10362/151586
dc.identifier.urlhttps://www.scopus.com/pages/publications/85150821379
dc.language.isoeng
dc.peerreviewedyes
dc.subjectfetal deterioration
dc.subjectfetal growth restriction
dc.subjectsFlt1/PlGF ratio
dc.subjectObstetrics and Gynaecology
dc.titleThe sFlt1/PlGF ratio predicts faster fetal deterioration in early fetal growth restrictionen
dc.title.subtitleA historical cohort studyen
dc.typejournal article
degois.publication.firstPage635
degois.publication.issue5
degois.publication.lastPage643
degois.publication.titleActa Obstetricia Et Gynecologica Scandinavica
degois.publication.volume102
dspace.entity.typePublication
rcaap.rightsopenAccess

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