Abstract
Objectives We examined how mid-pregnancy placental growth factor (PlGF) levels and uterine artery Dopplers predict adverse outcomes in a cohort of high-risk pregnancies. Methods Forty-six patients with high risk pregnancies were recruited between June 2011 and August 2012 from the UCSD Placenta Clinic. Serum PlGF measurements (Alere Inc. Triage platform) were collected and uterine artery (UtA) pulsatility index (PI) and notching were assessed by velocimetry at approximately 24 weeks. Adverse outcomes included pre-eclampsia (PET), pre-term birth 34 weeks (PTB), and/or SGA newborn (birth weight 10%). Results The median gestational age at recruitment was 24.6 weeks. Delivery outcomes were collected from 43 (93.5%) patients. The median gestational age at delivery was 38.9 weeks (range 26.4–41.3 weeks) and 37.2% of patients had Cesarean sections. 32.6% had an adverse outcome (11.6% PET, 4.7% PTB, 25.6% SGA). 16.3% had abnormal UtA Dopplers (mean UtA PI > 1.6 and/or bilateral UtA notching), with no significantly increased risk for an adverse outcome (RR 2.625, 95% CI 0.80–8.6). PlGF measurements were collected from 38 (82.6%) patients. The median PlGF was 287 pg/mL, and 4 patients (10.5%) had a low PlGF ( 55 pg/mL). All patients with a low PlGF had an adverse outcome. The 10 patients (27.0%) with an abnormal PlGF and/or UtA Doppler had a significantly increased risk of an adverse outcome (RR 4.04, 95% CI 1.2–14.2). Adding PlGF measurements to UtA Doppler screening at mid-pregnancy increased the positive likelihood ratio of predicting an adverse outcome from 1.4 to 2.4, and yields a negative likelihood ratio of 0.14. Conclusions There is a significant association between low PlGF at mid-pregnancy and subsequent adverse outcomes. Adding PLGF measurements to UtA Doppler screening improves prediction of adverse outcomes by 71%, as these combined modalities test placental and maternal maladaptation respectively at mid-pregnancy. Disclosures K. Kjos: None. R. Ghashghaei: None. K. Klisser: None. D. Woelkers: None.
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