Clinical use of angiogenesis biomarkers in fetal growth restriction: a narrative review

Angiogenesis biomarkers, particularly soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), are well-established surrogate markers of placental dysfunction in preeclampsia. Their role in fetal growth restriction (FGR) has gained increasing attention, but incorporation into routine clinical practice remains limited.

To evaluate and summarize the current evidence regarding the use of angiogenesis biomarkers for the prediction, diagnosis, and follow-up of FGR.

A narrative review was conducted through electronic searches of MEDLINE, EMBASE, the Cochrane Library, and Web of Science from inception to February 25, 2025. Relevant studies addressing angiogenic biomarkers in the context of FGR were identified and synthesized.

Evidence demonstrates that altered levels of sFlt-1 and PlGF reflect placental insufficiency and may tailor pregnancy monitoring and even decission making at different time-points in pregnancy. These biomarkers show promise for earlier identification of fetuses at risk of growth restriction, improved diagnostic accuracy when combined with ultrasound parameters, and enhanced monitoring of disease progression. Despite growing data, clinical adoption varies, and standardized use in FGR management is not yet established.

Angiogenesis biomarkers, particularly sFlt-1 and PlGF, represent valuable tools for predicting, diagnosing, and monitoring FGR. Their integration into clinical practice could optimize risk stratification and management, ultimately reducing adverse perinatal outcomes.