Journal of obstetrics and gynaecology Canada最新文献

{"title":"Laboratory Perspectives on Assay Selection and Implementation of PlGF-Based Testing for Suspected Preterm Preeclampsia","authors":"Paul M. Yip PhD,&nbsp;Lei Fu PhD","doi":"10.1016/j.jogc.2026.103427","DOIUrl":"10.1016/j.jogc.2026.103427","url":null,"abstract":"<div><div>Blood-based biomarker testing for placental growth factor (PlGF) for preeclampsia is gaining adoption as diagnostic assays have become increasingly available in Canada. However, guidance on the diagnostic and prognostic thresholds for various PlGF-based tests is not standardized nor interchangeable. The implementation of PlGF-based testing in a clinical setting requires laboratory support to advise on the assay selection due to test configuration, handling, and report interpretation. To support dialogue among clinicians and laboratory stakeholders, this brief review covers the currently available assays in Canada and describes their main studies in preterm preeclampsia, single cutoffs versus gestational age ranges, and technical considerations.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 8","pages":"Article 103427"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Non-Anemic Iron Deficiency in Early Pregnancy and Infant Neurodevelopment: A Critical Appraisal","authors":"Vanessa Giuliano MSc, MD,&nbsp;Grace H. Tang PhD,&nbsp;Michelle Sholzberg MSc, MD","doi":"10.1016/j.jogc.2026.103395","DOIUrl":"10.1016/j.jogc.2026.103395","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 8","pages":"Article 103395"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Iron Deficiency and Anemia in Pregnancy in a Canadian Cohort and Definition of Normal Hemoglobin Ranges in Iron-Replete Women","authors":"Khrystia MacKinnon MD, BSc,&nbsp;Ryan Lett MD,&nbsp;Christine Lett MD, BSc","doi":"10.1016/j.jogc.2026.103370","DOIUrl":"10.1016/j.jogc.2026.103370","url":null,"abstract":"<div><h3>Objectives</h3><div>The objectives were to identify the prevalence of iron deficiency and anemia in pregnancy and define the normal hemoglobin range in iron-replete women. Secondary outcomes included defining hemoglobin ranges by gestational age, identifying the prevalence of postpartum anemia, and evaluating the role of mean corpuscular volume for identifying iron deficiency.</div></div><div><h3>Methods</h3><div>A retrospective review of laboratory results from 1239 pregnant women without hemoglobinopathy was performed. Measurement of hemoglobin, iron studies, and ferritin were performed with routine gestational diabetes screening. Anemia was defined as hemoglobin &lt;110 g/L. Iron deficiency was defined as ferritin &lt;30 μg/L and/or iron percent saturation &lt;16%. Means and SDs or medians and IQRs were calculated, as appropriate.</div></div><div><h3>Results</h3><div>A total of 89% (1102 of 1239) of women were iron deficient. Of the 7% (89 of 1239) who were anemic, 94% (84 of 89) were iron deficient. The mean gestational age was 26.2 (SD 2.7) weeks. The median hemoglobin was 121 g/L (IQR 10, range 92–150g/L). The median hemoglobin in the 137 iron-replete women was 124 g/L (IQR 9, range 100–147g/L). After excluding the bottom 5%, the lower limit of hemoglobin in iron-replete women was 110 g/L.</div></div><div><h3>Conclusions</h3><div>Iron deficiency is common in pregnancy and cannot be recognized solely by hemoglobin assessment. Iron studies should be included in routine prenatal bloodwork to identify and treat women with iron deficiency. The current threshold for defining anemia in pregnancy may be too low. Further research with more iron-replete women is needed to define hemoglobin reference ranges in pregnancy. Clinicians should recognize that a hemoglobin level below 110 g/L in pregnancy warrants investigation.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 8","pages":"Article 103370"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron Deficiency and Iron Deficiency Anemia in Pregnancy: A Narrative Review for Canadian Obstetrical Practice","authors":"Christine Lett MD, BSc","doi":"10.1016/j.jogc.2026.103369","DOIUrl":"10.1016/j.jogc.2026.103369","url":null,"abstract":"<div><div>Iron deficiency is the most common medical condition encountered during pregnancy and remains substantially underdiagnosed when screening relies on hemoglobin alone. Even in high-income countries such as Canada, iron deficiency affects most pregnant women. Iron deficiency and iron deficiency anemia are associated with increased maternal, perinatal, and neonatal morbidity and mortality, including adverse neurodevelopmental outcomes. This narrative review summarizes the epidemiology, physiology, clinical consequences, screening strategies, and management of iron deficiency in pregnancy, with a focus on implications for obstetrical practice in Canada.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 8","pages":"Article 103369"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"sFlt-1:PlGF Testing Implementation: Introducing Practice Improvement Using Principles of Change Management","authors":"Harrison Banner MD, MSc,&nbsp;Michael Knauer PhD,&nbsp;Angela C. Rutledge PhD","doi":"10.1016/j.jogc.2026.103415","DOIUrl":"10.1016/j.jogc.2026.103415","url":null,"abstract":"<div><div>Placental growth factor (PlGF) and the ratio of soluble fms-like tyrosine kinase-1 to PlGF have been shown to be useful tests for early detection and diagnosis of preeclampsia. This paper outlines the process of implementing soluble fms-like tyrosine kinase-1:PlGF testing at our institution, drawing on theories and principles of change management. Alongside clinical and cost considerations, inter-departmental relationship building, stakeholder buy-in, and case building were essential in bringing this testing into practice at our institution.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 8","pages":"Article 103415"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active Management of Anemia: Applying Patient Blood Management Principles to Improve Patient Outcomes","authors":"Ryan Lett MD","doi":"10.1016/j.jogc.2026.103359","DOIUrl":"10.1016/j.jogc.2026.103359","url":null,"abstract":"<div><div>Anemia is a risk factor for adverse outcomes in medical, surgical, and pregnant populations. Anemia starts at a hemoglobin of 130 g/L and should always be investigated before surgery or as soon as it is identified. Transfusion should be abandoned as therapy for asymptomatic anemia when there is an underlying correctable condition. Treating the underlying etiology and providing the building blocks for the patient to produce their own hemoglobin is the global standard of care and a foundational tenet of patient blood management.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 8","pages":"Article 103359"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soluble fms-Like Tyrosine Kinase-1 to Placental Growth Factor Ratio for the Prediction of Preeclampsia in Asymptomatic Women","authors":"Brielle Demuth BHSc,&nbsp;Deborah Cavalcanti BSc,&nbsp;Paul Guerby MD, PhD,&nbsp;Ariane Pellan BSc,&nbsp;Camille Blouin MD,&nbsp;Anthony Lévesque MSc,&nbsp;Amélie Boutin PhD,&nbsp;Yves Giguère MD, PhD,&nbsp;Jean-Claude Forest MD, PhD,&nbsp;Louise Ghesquière MD, PhD,&nbsp;Emmanuel Bujold MD, MSc","doi":"10.1016/j.jogc.2026.103373","DOIUrl":"10.1016/j.jogc.2026.103373","url":null,"abstract":"<div><h3>Objectives</h3><div>The ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) over placental growth factor (PlGF) increases before clinical onset in women with suspected preeclampsia (PE). We aimed to estimate its value in asymptomatic patients.</div></div><div><h3>Methods</h3><div>We recruited nulliparous patients in the first trimester, invited to attend a 20⁰–24⁶ and 30⁰–34⁶ weeks' gestation visit for maternal blood sampling used for measurement of the sFlt-1/PlGF ratio (using B·R·A·H·M·S KRYPTOR analyzer). The primary outcome was PE stratified by gestational age at delivery: preterm (&lt;37 weeks) subdivided into early (&lt;34 weeks) and late (34–36 weeks) preterm; and term (≥37 weeks) PE. Analyses included area under the receiver operating characteristic curves and the Youden index.</div></div><div><h3>Results</h3><div>Among 845 women recruited, 832 (98%) had complete data, including 4 (0.5%) early, 4 (0.5%) late-preterm, and 26 (3.1%) term PE. At 20⁰–24⁶ weeks gestation, the sFlt-1/PlGF ratio was highly associated with early (area under the receiver operating characteristic curve [AUC] 0.99; 95% CI 0.99–1.00; sensitivity: 100% specificity: 99%) but not late-preterm or term PE. At 30⁰–34⁶ weeks, the sFlt-1/PlGF ratio accurately discriminated preterm cases (AUC 0.96; 95% CI 0.89–1.00; sensitivity: 86% specificity: 98%) and moderately discriminated term cases (AUC 0.71; 95% CI 0.58–0.83; sensitivity: 42% specificity: 93%).</div></div><div><h3>Conclusions</h3><div>Maternal sFlt-1/PlGF ratio is increased at 20–24 weeks gestation among asymptomatic women who will develop early PE and at 30–34 weeks among those who will develop preterm PE. The discriminatory performance of the sFlt-1/PlGF ratio varies according to gestational age at screening and gestational age at delivery.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 7","pages":"Article 103373"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-Trimester Placental Growth Factor and HELLP Syndrome: The PREDICTION Study","authors":"Emmanuel Bujold MD, MSc,&nbsp;Kypros H. Nicolaides MD,&nbsp;Nan Okun MD,&nbsp;Jo-Ann Jonhson MD,&nbsp;Francois Audibert MD, MSc,&nbsp;Jean-Claude Forest MD, PhD,&nbsp;Yves Giguère MD, PhD,&nbsp;Louise Ghesquiere MD, PhD,&nbsp;Paul Guerby MD, PhD","doi":"10.1016/j.jogc.2026.103390","DOIUrl":"10.1016/j.jogc.2026.103390","url":null,"abstract":"<div><h3>Objectives</h3><div>Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a complication of preeclampsia. We aimed to estimate the association between first-trimester placental growth factor (PlGF) and other preeclampsia risk factors with HELLP syndrome.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis of a prospective cohort of nulliparous women recruited at 11 weeks 0 days – 14 weeks 0 days gestation and stratified according to pregnancy outcome: HELLP syndrome, preeclampsia without HELLP syndrome, or neither (controls). We compared the 3 groups for first-trimester maternal age, BMI, mean arterial pressure, uterine artery pulsatility index, and serum PlGF in multiples of the median (MoM), using non-parametric and receiver-operator characteristics curve analyses.</div></div><div><h3>Results</h3><div>Of the 7325 eligible participants, 27 (0.4%) developed HELLP syndrome and 228 (3.1%) developed preeclampsia without HELLP. Median PlGF was lower in the preeclampsia (median: 0.85 MoM; IQR 0.61–1.15; <em>P</em> &lt; 0.001), and HELLP syndrome (0.72 MoM; IQR 0.55–1.09, <em>P</em> &lt; 0.001) groups than in controls (1.02 MoM; IQR 0.72–1.43). At PlGF ≤0.7 MoM, the prediction rate for preterm and term HELLP was 56% and 33%, respectively, and the respective values for preeclampsia without HELLP were 50% and 30%, respectively, at a false-positive rate of 17%. In HELLP syndrome, unlike preeclampsia without HELLP, there was no association with first-trimester BMI, mean arterial pressure, or uterine artery pulsatility index.</div></div><div><h3>Conclusions</h3><div>First-trimester low PlGF was the only factor associated with HELLP syndrome.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 7","pages":"Article 103390"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147871291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placental Growth Factor as a Diagnostic Test for Preeclampsia in Canada: A Call to Action","authors":"Kelsey McLaughlin PhD,&nbsp;John W. Snelgrove MD, MSc","doi":"10.1016/j.jogc.2026.103410","DOIUrl":"10.1016/j.jogc.2026.103410","url":null,"abstract":"","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 7","pages":"Article 103410"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148261084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placental Growth Factor and Compromised Fetal Growth: Associations with Placental Ultrasound Morphology and Pathology in a Retrospective Cohort Study","authors":"Ernesto A. Figueiro-Filho MD, PhD,&nbsp;Genevieve M. Dietrich BSc, Meng,&nbsp;Adrielle P. Souza Lira BSN, RN,&nbsp;Eman Ramadan MD,&nbsp;Adewumi Adanlawo MD,&nbsp;Pedro Henrique Goncalves Guedes PhD,&nbsp;Ana Paula Mendes-Silva PhD","doi":"10.1016/j.jogc.2026.103371","DOIUrl":"10.1016/j.jogc.2026.103371","url":null,"abstract":"<div><h3>Objectives</h3><div>Fetal growth restriction (FGR) is often associated with placental dysfunction. Circulating placental growth factor (PlGF) is a promising biomarker for identifying pregnancies at risk of placental disease and FGR. This study evaluated how maternal PlGF levels relate to fetal growth and adverse perinatal outcomes, and how compromised growth relates to placental morphology/pathology and perinatal outcomes.</div></div><div><h3>Methods</h3><div>Retrospective cohort of 305 patients. Maternal PlGF levels were measured as the primary exposure. The primary outcome was compromised fetal growth (FGR/small for gestational age versus normal growth) defined by Delphi criteria. Secondary outcomes included abnormal sonographic placental morphology, placental pathology demonstrating maternal or fetal vascular malperfusion, preeclampsia, intrauterine fetal demise, preterm birth &lt;34 weeks, birthweight &lt;third percentile, and neonatal intensive care unit admission.</div></div><div><h3>Results</h3><div>Low PlGF was strongly associated with compromised fetal growth (OR 4.6; 95% CI 2.7–7.8, <em>P</em> &lt; 0.0001). Compromised fetal growth was associated with abnormal placental morphology (OR 4.2; 95% CI 2.5–7.2), maternal/fetal vascular malperfusion on pathology (OR 15.5; 95% CI 5.2–46.3) and adverse perinatal outcomes, including intrauterine fetal demise, preterm birth &lt;34 weeks, birthweight &lt;third percentile, and neonatal intensive care unit admission. Differences in gestational age at first visit and delivery were significant across growth categories (<em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>Low PlGF levels and abnormal placental morphology are strong indicators of placental dysfunction and FGR, even when independent of preeclampsia. Incorporating PlGF testing into high-risk pregnancies’ management may enable earlier identification of compromised growth and improve obstetric outcomes, particularly in settings with limited resources.</div></div>","PeriodicalId":16688,"journal":{"name":"Journal of obstetrics and gynaecology Canada","volume":"48 7","pages":"Article 103371"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}