Prediction of Fetal Growth Restriction Using Serum PlGF Combined with PAPP-A in Early Pregnancy.

Objective: This study aimed to assess the predictive capacity of placenta growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) levels in the serum of pregnant women during early pregnancy (11-13⁺⁶ weeks) for fetal growth restriction (FGR).

Patients and methods: A retrospective cohort study was conducted involving 1602 pregnant women who gave birth at The Second Nanning People's Hospital between March 2018 and September 2019. Serum concentrations of PlGF and PAPP-A were measured during early pregnancy for all participants. Based on pregnancy outcomes, participants were categorized into the FGR group (n = 94) and the normal control group (n = 1508). Clinical characteristics, serum PAPP-A, and PlGF levels during early pregnancy (11-13⁺⁶ weeks) were compared between the two groups using t-tests and one-way analysis of variance. Receiver operating characteristic (ROC) curves were generated to assess the predictive value of each biomarker.

Results: The overall incidence of FGR in the study cohort was 5.86%. Pregnant women in the FGR group exhibited significantly lower serum levels of PlGF and PAPP-A compared to the control group (both p<0.05). Correlation analysis revealed that PAPP-A levels were inversely associated with maternal age, pre-pregnancy body mass index (BMI), platelet count, and fibrinogen (all p<0.05). ROC analysis demonstrated that the area under the curve (AUC) for predicting FGR was 0.734 (95% CI: 0.677-0.790) for PlGF and 0.729 (95% CI: 0.676-0.781) for PAPP-A, which indicates a certain individual predictive value. When combined, the predictive efficiency slightly improved (AUC=0.742).

Conclusion: Serum levels of PlGF and PAPP-A in early pregnancy can effectively predict FGR, with slightly improved predictive accuracy when used together, presenting a new method for early FGR screening.