ABSTRACT
Objective
Placental growth factor (PlGF) levels are lower at delivery in pregnancies with preeclampsia
or fetuses small for gestational age (SGA). These obstetrical complications are typically
mediated by placental dysfunction, most commonly related to the specific placental
phenotype termed placental maternal vascular malperfusion (MVM). The objective of
this study was to determine the relationship between PlGF levels in the second trimester
and the development of placental diseases that underlie adverse perinatal outcomes.
Methods
We performed a secondary analysis of the prospective Placental Health Study in unselected
healthy nulliparous women (n = 773). Maternal demographic data, Doppler ultrasound
measurements, and plasma PlGF levels at 15 to 18 weeks gestation were analyzed for
association with pregnancy outcomes and placental pathology following delivery.
Results
Low PlGF levels in the second trimester (<10th percentile; <72 pg/mL) was associated
with preterm delivery (<37 weeks; 26% vs. 6%, P < 0.001; unadjusted odds ratio (OR) 5.75, 95% CI 3.2–10.5), reduced mean birth weight
(2998 vs. 3320 g, P < 0.001), SGA deliveries (25% vs. 11%, P = 0.001; OR 2.6, 95% CI 1.5–4.6), and preeclampsia (7% vs. 2%, P = 0.02; OR 4.3, 95% CI 1.5-12.8) relative to normal PlGF levels (≥10th percentile;
≥72 pg/mL). Low PlGF was associated with lower mean placental weight (447 vs. 471
g, P = 0.01), aberrant cord insertion (25% vs. 12%, P = 0.001) and a pathologic diagnosis of MVM (18% vs. 11%, P = 0.04; OR 1.9, 95% CI 1.01–3.55) but not with other placental pathologies.
Conclusion
MVM placental pathology and related adverse perinatal outcomes are associated with
low PlGF in the early second trimester for healthy nulliparous women.
RÉSUMÉ
Objectif
Le taux de facteur de croissance placentaire (PlGF) est plus faible à l'accouchement
en cas de grossesse pré-éclamptique ou d'hypotrophie fœtale. Ces complications obstétricales
résultent généralement d'une dysfonction placentaire, qui est le plus souvent liée
à un phénotype placentaire en particulier, soit la malperfusion vasculaire d'origine
maternelle. L'objectif de cette étude était de déterminer la relation entre le taux
de PlGF au deuxième trimestre et l'apparition de maladies placentaires qui sont à
l'origine des issues périnatales défavorables.
Méthodologie
Nous avons effectué une analyse secondaire de l’étude prospective sur la santé placentaire
(Placental Health Study) chez des femmes nullipares en bonne santé non sélectionnées
(n = 773). Les données démographiques maternelles, les résultats de l’échographie
Doppler et le taux plasmatique de PlGF entre 15 et 18 semaines d'aménorrhée (SA) ont
été analysés pour déterminer l'association avec les issues de grossesse et les pathologies
placentaires après l'accouchement.
Résultats
Un faible taux de PlGF au deuxième trimestre (< 10e percentile; < 72 pg/ml) était associé à l'accouchement prématuré (< 37 SA; 26 % vs
6 %, P < 0,001; rapport de cotes [RC] non ajusté : 5,75; IC à 95 % : 3,2–10,5), à une diminution
du poids moyen à la naissance (2 998 g vs 3 320 g, P < 0,001), à l'hypotrophie fœtale à la naissance (25 % vs 11 %, P = 0,001; RC 2,6; IC à 95 % : 1,5–4,6) et à la pré-éclampsie (7 % vs 2 %, P = 0,02; RC : 4,3; IC à 95 % : 1,5–12,8) comparativement à un taux de PlGF normal
(≥10e percentile; ≥72 pg/mL). Le faible taux de PlGF, par comparaison à un taux normal,
était associé à un poids placentaire moyen moins élevé (447 g vs 471 g, P = 0,01), à une insertion anormale du cordon ombilical (25 % vs 12 %, P = 0,001) et à un diagnostic anatomopathologique de malperfusion vasculaire d'origine
maternelle (18 % vs 11 %, P = 0,04; RC : 1,9; IC à 95 % : 1,01–3,55), mais pas à d'autres pathologies placentaires.
Conclusion
La malperfusion vasculaire d'origine maternelle et les issues périnatales défavorables
connexes sont associées à un faible taux de PlGF au début du deuxième trimestre chez
les femmes nullipares en bonne santé.
Keywords
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Article info
Publication history
Published online: February 20, 2021
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated they meet the journal's requirements for authorship.
Identification
Copyright
© 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
