Non-invasive prediction of fetal growth restriction in pre-eclampsia: integrating peripheral blood endothelial progenitor cell count with uterine artery Doppler velocimetry

Objective

To investigate the predictive value of peripheral blood endothelial progenitor cells (EPCs) combined with uterine artery resistance index (RI) and pulsatility index (PI) for fetal growth restriction (FGR) in patients with pre-eclampsia (PE).

Methods

A retrospective study was conducted on 265 PE patients. Based on pregnancy outcomes, they were categorized into FGR and N-FGR groups. EPCs and RI/PI were analyzed using flow cytometry and Doppler ultrasonography. The correlations of EPCs with RI/PI in PE complicated with FGR, predictive value of EPCs, RI, PI and their combination for FGR in PE, and factors influencing FGR occurrence in PE were analyzed by Pearson correlation, ROC, and multivariate logistic regression analyses.

Results

In this PE cohort, the prevalence of FGR was 33.58% (89/265). Compared to the N-FGR group, the FGR group exhibited significantly lower EPCs and higher RI/PI. The Early-FGR group showed reduced EPCs and elevated RI/PI than the Late-FGR group. EPC count significantly inversely correlated with RI/PI in PE-FGR patients. The combination of EPCs, RI, and PI demonstrated superior predictive accuracy for FGR in PE. PE classification (OR = 5.501), RI (OR = 1.422), and peripheral blood EPCs (OR = 0.044) independently correlated with FGR occurrence, and PLT (OR = 0.986) and PlGF (OR = 0.942) independently correlated with reduced EPCs in PE patients.

Conclusion

Reduced peripheral blood EPCs and elevated uterine artery RI/PI are closely associated with FGR progression in PE, and their combination presents high predictive value for PE-related FGR. EPCs and RI are independently correlated with PE-related FGR, indicating their potentials for clinical prevention, diagnosis, and treatment of PE-related FGR.