Search

Objective: To assess the utility of placental growth factor (PlGF) levels and the soluble fms‐like tyrosine kinase‐1/placental growth factor (sFlt‐1/PlGF) ratio to predict preterm birth (PTB) for infants with fetal growth restriction (FGR) and those appropriate for gestational age (AGA). Design: Prospective, observational cohort study. Setting: Tertiary maternity hospital in Australia. Population: There were 320 singleton pregnancies: 141 (44.1%) AGA, 83 (25.9%) early FGR (<32+0 weeks) and 109 (30.0%) late FGR (≥32+0 weeks). Methods: Maternal serum PlGF and sFlt‐1/PlGF ratio were measured at 4‐weekly intervals from recruitment to delivery. Low maternal PlGF levels and elevated sFlt‐1/PlGF ratio were defined as <100 ng/L and >5.78 if <28 weeks and >38 if ≥28 weeks respectively. Cox proportional hazards models were used. The analysis period was defined as the time from the first measurement of PlGF and sFlt‐1/PlGF ratio to the time of birth or censoring. Main outcome measures: The primary study outcome was overall PTB. The relative risks (RR) of birth within 1, 2 and 3 weeks and for medically indicated and spontaneous PTB were also ascertained. Results: The early FGR cohort had lower median PlGF levels (54 versus 229 ng/L, p < 0.001) and higher median sFlt‐1 levels (2774 ng/L versus 2096 ng/L, p < 0.001) and sFlt‐1/PlGF ratio higher (35 versus 10, p < 0.001). Both PlGF <100 ng/L and elevated sFlt‐1/PlGF ratio were strongly predictive for PTB as well as PTB within 1, 2 and 3 weeks of diagnosis. For both FGR and AGA groups, PlGF <100 ng/L or raised sFlt‐1/PlGF ratio were strongly associated with increased risk for medically indicated PTB. The highest RR was seen in the FGR cohort when PlGF was <100 ng/L (RR 35.20, 95% CI 11.48–175.46). Conclusions: Low maternal PlGF levels and elevated sFlt‐1/PlGF ratio are potentially useful to predict PTB in both FGR and AGA pregnancies. [ABSTRACT FROM AUTHOR]

Introduction: To assess the rate of change in soluble fms‐like tyrosine kinase‐1/placental growth factor (sFlt‐1/PlGF) ratio and PlGF levels per week compared to a single sFlt‐1/PlGF ratio or PlGF level to predict preterm birth for pregnancies complicated by fetal growth restriction. Material and methods: A prospective cohort study of pregnancies complicated by isolated fetal growth restriction. Maternal serum PlGF levels and the sFlt‐1/PlGF ratio were measured at 4‐weekly intervals from recruitment to delivery. We investigated the utility of PlGF levels, sFlt‐1/PlGF ratio, change in PlGF levels per week or sFlt‐1/PlGF ratio per week. Cox‐proportional hazard models and Harrell's C concordance statistic were used to evaluate the effect of biomarkers on time to preterm birth. Results: The total study cohort was 158 pregnancies comprising 91 (57.6%) with fetal growth restriction and 67 (42.4%) with appropriate for gestational age controls. In the fetal growth restriction cohort, sFlt‐1/PlGF ratio and PlGF levels significantly affected time to preterm birth (Harrell's C: 0.85–0.76). The rate of increase per week of the sFlt‐1/PlGF ratio (hazard ratio [HR] 3.91, 95% confidence interval [CI]: 1.39–10.99, p = 0.01, Harrell's C: 0.74) was positively associated with preterm birth but change in PlGF levels per week was not (HR 0.65, 95% CI: 0.25–1.67, p = 0.37, Harrell's C: 0.68). Conclusions: Both a high sFlt‐1/PlGF ratio and low PlGF levels are predictive of preterm birth in women with fetal growth restriction. Although the rate of increase of the sFlt‐1/PlGF ratio predicts preterm birth, it is not superior to either a single elevated sFlt‐1/PlGF ratio or low PlGF level. [ABSTRACT FROM AUTHOR]

Background: While a male infant is usually born with a higher birthweight than his female counterpart, he is more at risk of variety of adverse perinatal outcomes. Indeed, throughout life, females exhibit a marked survival advantage compared to males. The aetiology for such pertinent sex disparity remains unclear and is likely multifactorial. Aims: The aim of this study was to investigate obstetric and perinatal outcomes by infant sex from 28 weeks in a contemporary, large Australian birth cohort. Materials and Methods: A 14‐year retrospective cohort study of 130 133 births over 28 weeks gestation from a single tertiary centre. Results: Male infants had overall higher rates of neonatal mortality (0.12% vs 0.06%, P < 0.001) and severe neonatal morbidity (12% vs 9.1%, P < 0.001) (adjusted odds ratio (aOR) 1.41, 95% CI 1.35–1.47). The odds of overall perinatal mortality (stillbirth and neonatal death) were higher for male infants (aOR 1.30, 95% CI 1.08–1.56). The difference in severe neonatal morbidity when stratified by gestational age at birth only remained significant from >35 weeks gestation. Regardless of infant sex, rates of neonatal mortality and morbidity were lowest at 39 weeks gestation. Rates of preterm birth and operative birth were also higher for male infants. Conclusions: Our study demonstrates significant disparities in clinical outcomes by infant sex with males at a disadvantage to female infants. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to evaluate the association of a low cerebroplacental ratio (CPR) with hypoxic ischaemic encephalopathy (HIE), severe neonatal morbidity (SNM) and perinatal mortality (PNM). Methods: This was a retrospective cohort study of late‐preterm and term births at Mater Mothers' Hospital, Brisbane, between 2016 and 2020. Study outcomes were HIE, PNM and SNM (a composite of severe acidosis, Apgar score less than four at 5 min, severe respiratory distress or need for significant cardiopulmonary resuscitation at birth). Univariate and multivariable logistic regressions were used to determine if a low CPR was associated with HIE, SNM or PNM. Results: A total of 51 870 births met the inclusion criteria. Of these, 216 (0.42%) were complicated by HIE, 10 224 (19.7%) had SNM and 251 (0.48%) had PNM. Rates of low CPR (<10th and <5th centile) were significantly higher in the SNM cohort (20.1 and 13.2%, respectively) and PNM cohort (21.1 and 15.1%, respectively) compared to the overall cohort. A low CPR was associated with significantly increased adjusted odds for SNM but not for HIE or PNM. The area under the receiver operating characteristic curve for CPR <10th centile was greatest for SNM (0.768) and lowest for HIE (0.595). Predictive margins of a low CPR for HIE, SNM and PNM were significant only for SNM at late‐preterm gestations. Conclusions: A low CPR is associated with increased odds of SNM in infants born >34 weeks' gestation but not for HIE or PNM. [ABSTRACT FROM AUTHOR]