Association between second-trimester sFlt-1/PlGF ratio and composite adverse neonatal outcome in patients with...

To investigate the predictive performance of the second-trimester soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio for composite adverse neonatal outcome (CANO) in preeclampsia (PE).

This retrospective cohort study enrolled 253 PE women during June 2022-June 2024. Maternal serum levels of sFlt-1 and PlGF were assessed, and their ratio was determined at 13-27 gestational weeks. Subjects were stratified into CANO (n = 80) and non-CANO (n = 173) groups. Baseline characteristics and the sFlt-1/PlGF ratio were compared. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors for CANO. Predictive value was assessed using ROC curve analysis, and a nomogram prediction model was constructed.

The sFlt-1/PlGF ratio was markedly higher in the CANO group than the non-CANO group (p < 0.001). Multivariate analysis identified the sFlt-1/PlGF ratio (OR = 1.040, 95% CI: 1.020-1.060, p < 0.001), serum uric acid level (OR = 1.007, 95% CI: 1.000-1.013, p = 0.043), and history of pre-pregnancy hypertension (OR = 13.51, 95% CI: 2.065-88.36, p = 0.007) as independent risk factors for CANO. Conversely, gestational age at delivery (OR = 0.727, 95% CI: 0.621-0.852, p < 0.001) was a protective factor. The sFlt-1/PlGF ratio predicted CANO with an AUC of 0.799 (95% CI: 0.743-0.855). The integrated nomogram model achieved a C-index of 0.880 (95% CI: 0.836-0.923), indicating excellent discrimination.

The second-trimester sFlt-1/PlGF ratio is an independent predictor for CANO in PE. A model incorporating this biomarker facilitates the early identification of high-risk neonates, informing personalized perinatal management.