Implementation of Placental Growth Factor (PlGF) in a Tertiary Western Canadian Centre: Association with Ultrasound findings and Perinatal Outcomes.

Objective: To evaluate the association between placental growth factor (PlGF) levels, ultrasound findings, and perinatal outcomes in a high-risk pregnant population at a tertiary referral centre in Western Canada, and to assess the predictive performance of the PlGF test.

Methods: We conducted a retrospective cohort study of 389 high-risk pregnant individuals who underwent PlGF testing between 12+0 and 36+0 weeks' gestation. Participants were stratified by PlGF levels: normal (≥ 10th centile), inconclusive (5th-9th centile), and low (≤ 5th centile). Clinical, biochemical, ultrasound, and perinatal outcomes were compared across groups. Odds ratios, sensitivity, specificity, and predictive values were calculated.

Results: Low PlGF levels were observed in 33.9% pregnancies, with testing performed at a median gestational age of 27.7 weeks. Low PlGF levels were significantly associated with higher maternal BMI, elevated blood pressure, and increased creatinine, uric acid, and proteinuria levels. Ultrasound findings in the low PlGF group revealed higher rates of fetal growth restriction, abnormal Doppler studies, and abnormal placental morphology. These pregnancies had increased incidence of preterm birth <34 weeks (52/132 39.3%), preeclampsia (69/132 52.3%), NICU admissions (54/132 40.9%), and small-for-gestational-age neonates (15/132 11.4%). Most negative predictive values exceeded 90%.

Conclusion: Low maternal PlGF levels are strongly associated with ultrasound and biochemical indicators of placental dysfunction and adverse perinatal outcomes. PlGF testing may serve as an effective risk stratification tool in high-risk pregnancies, particularly in rural and underserved populations.