title: Angiogenic factors vs Doppler surveillance in the prediction of adverse outcome among late-pregnancy small-for- gestational-age fetuses.
abstract: OBJECTIVE
  To compare the value of Doppler surveillance with maternal blood angiogenic factors at diagnosis for the prediction of adverse outcome in late-pregnancy small-for-gestational-age (SGA) fetuses.
  
  
  METHODS
  In a cohort of 198 SGA fetuses we evaluated the association of Doppler indices (mean uterine artery pulsatility index (UtA-PI) and cerebroplacental ratio (CPR)) and angiogenic factors (maternal serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF)) with the development of pre-eclampsia and adverse perinatal outcome (operative delivery for non-reassuring fetal status or neonatal metabolic acidosis).
  
  
  RESULTS
  In SGA fetuses subsequently developing pre-eclampsia, mean UtA-PI (P < 0.001), sFlt-1 MoM (P < 0.001) and sFlt-1/PlGF MoM ratio (P < 0.001) were higher, while PlGF MoM was lower (P = 0.004). In SGA fetuses with adverse perinatal outcome, CPR (P < 0.002) and PlGF MoM (P < 0.001) were lower, and sFlt-1/PlGF MoM ratio was higher (P = 0.001). For predicting pre-eclampsia, the areas under the receiver-operating characteristics (ROC) curves for mean UtA-PI, sFlt-1 MoM and the combination of both were 0.852, 0.839 and 0.860, respectively. For adverse perinatal outcome, the areas under the ROC curves for CPR, PlGF MoM and the combination of both were 0.652, 0.656 and 0.684, respectively. The combination of Doppler indices and angiogenic factors did not significantly improve prediction of either pre-eclampsia (P = 0.851) or adverse outcome (P = 0.579).
  
  
  CONCLUSIONS
  In SGA fetuses, angiogenic factors at diagnosis and follow-up with Doppler ultrasound both predict adverse outcome with a similar performance.
authors.affiliation: Maternal-Fetal Medicine Department, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Fetal and Perinatal Medicine Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain; Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany.
authors.forename: S M
authors.initials: SM
authors.lastname: Lobmaier
authors.forename: F
authors.initials: F
authors.lastname: Figueras
authors.forename: I
authors.initials: I
authors.lastname: Mercade
authors.forename: M
authors.initials: M
authors.lastname: Perello
authors.forename: A
authors.initials: A
authors.lastname: Peguero
authors.forename: F
authors.initials: F
authors.lastname: Crovetto
authors.forename: J U
authors.initials: JU
authors.lastname: Ortiz
authors.forename: F
authors.initials: F
authors.lastname: Crispi
authors.forename: E
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D043925:Angiogenesis Inducing Agents / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005312:Fetal Blood; D005317:Fetal Growth Retardation / Q000097:blood* / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006801:Humans; D007236:Infant, Small for Gestational Age; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D011673:Pulsatile Flow; D012372:ROC Curve; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*; D055988:Uterine Artery / Q000000981:diagnostic imaging*
chemical_list: D043925:Angiogenesis Inducing Agents; D015415:Biomarkers
keywords: Doppler; PlGF; SGA; angiogenic factors; placental growth factor; sFlt-1; soluble fms-like tyrosine kinase-1