title: Angiogenic proteins, placental weight and perinatal outcomes among pregnant women in Tanzania.
abstract: BACKGROUND
  Placental vascular development, and ultimately placental weight, is essential to healthy fetal development. Here, we examined placental weight in a cohort of Tanzanian women in association with angiogenic proteins known to regulate placental vascular development and perinatal outcomes.
  
  
  METHODS
  A total of n = 6579 women with recorded placental weight were included in this study. The relative risk of adverse perinatal outcomes (Apgar score, death, asphyxia, respiratory distress, seizures, pneumonia and sepsis) was compared between placental weight in the bottom and top 10th percentiles. We quantified angiogenic mediators (Ang-1, Ang-2, VEGF, PGF and sFlt-1) in plasma samples (n = 901) collected between 12 to 27 weeks of pregnancy using ELISA and assessed the relative risk of placental weight in the bottom and top 10th percentiles by protein levels in quartiles.
  
  
  RESULTS
  Women with Ang-2 levels in the highest quartile had an increased relative risk of placental weight in the bottom 10th percentile (RR = 1.45 (1.10, 1.91), p = 0.01). Women with VEGF-A (RR = 0.73 (0.56, 0.96), p = 0.05) and PGF (RR = 0.58 (0.44, 0.72), p = 0.002) in the highest quartile had a reduced relative risk of placental weight in the bottom 10th percentile. Low placental weight (in bottom 10th percentile) was associated with an increased relative risk of Apgar score of <7 at 1 minute (RR = 2.31 (1.70, 3.13), p = 0.001), at 5 minutes (RR = 3.53 (2.34, 5.33), p = 0.001), neonatal death (RR = 5.02 (3.61, 7.00), p = 0.001), respiratory distress (RR = 4.80(1.71, 13.45), p = 0.001), and seizures (RR = 4.18 (1.16, 15.02), p = 0.03).
  
  
  CONCLUSIONS
  The association between low placental weight and risk of adverse perinatal outcomes in this cohort suggests that placental weight could serve as a useful indicator, providing additional insight into high-risk pregnancies and identifying neonates that may require additional monitoring and follow-up.
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.|SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada.
authors.forename: Chloe R
authors.initials: CR
authors.lastname: McDonald
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.|Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Darling
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
authors.forename: Enju
authors.initials: E
authors.lastname: Liu
authors.affiliation: SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Tran
authors.affiliation: SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada.
authors.forename: Ana
authors.initials: A
authors.lastname: Cabrera
authors.affiliation: Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.affiliation: Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Willy
authors.initials: W
authors.lastname: Urassa
authors.affiliation: SAR Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada.|Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kain
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.|Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D042501:Angiogenic Proteins / Q000032:analysis*; D001034:Apgar Score; D005260:Female; D006801:Humans; D009929:Organ Size; D010920:Placenta / Q000033:anatomy & histology / Q000098:blood supply / Q000502:physiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D042501:Angiogenic Proteins