Midpregnancy Placental Growth Factor Screening and Early Preterm Birth

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Early preterm birth (<34 weeks' gestation) poses significant health risks to newborns.
• Current screening strategies for early preterm birth are not universal, limiting timely interventions.
• Identifying high-risk pregnancies is crucial for effective prenatal care and improved outcomes.

Purpose of the Study:

• To assess the efficacy of midpregnancy placental growth factor (PlGF) screening in identifying pregnancies at elevated risk for early preterm birth.
• To determine the predictive value of low PlGF levels for adverse perinatal outcomes.

Main Methods:

• Prospective cohort study involving unselected pregnant individuals undergoing routine prenatal care.
• Placental growth factor (PlGF) testing was performed during gestational diabetes screening (24-28 weeks' gestation).
• Analysis of PlGF levels (<100 pg/mL) and their association with early preterm birth and other adverse outcomes.

Main Results:

• A low PlGF level (<100 pg/mL) demonstrated high specificity (99.5%) and a positive likelihood ratio of 79.4 for early preterm birth.
• Low PlGF levels were significantly associated with increased risk of stillbirth (aRR, 36.78) and iatrogenic early preterm birth (aRR, 92.11).
• The area under the curve (AUC) for predicting early preterm birth was 0.80, and for iatrogenic early preterm birth, it was 0.90.

Conclusions:

• Midpregnancy PlGF screening (<100 pg/mL) is a valuable tool for identifying pregnancies at high risk of early preterm birth, particularly iatrogenic cases.
• Targeted allocation of tertiary healthcare resources to high-risk pregnancies identified by PlGF screening can potentially enhance maternal and perinatal health.
• This screening approach offers a pathway to more personalized and effective interventions for preventing adverse pregnancy outcomes.