Maternal vascular malformation in the placenta is an indicator for fetal growth restriction irrespective of neonatal birthweight

M. L. E. Hendrix*, J. A. P. Bons, N. O. Alers, C. A. H. Severens-Rijvers, M. E. A. Spaanderman, S. Al-Nasiry

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction: To study the association between placental pathology and neonatal birthweight and outcomes, and whether a combination of first trimester biomarkers and fetal growth velocity can predict placental lesions.

Methods: The presence of maternal vascular malperfusion (MVM) lesions (Amsterdam criteria) was recorded in a retrospective cohort of singleton pregnancies in the Maastricht University Medical Centre, 2011-2018. First trimester maternal characteristics and PAPP-A, PlGF and sFlt-1 levels were collected. Fetal growth velocities were calculated (mm/week) from 20 to 32 weeks for abdominal circumference, biparietal diameter, head circumference and femur length. Data were compared between neonates with 'small for gestational age' (SGA <p10) and different categories of 'appropriate for gestational age (AGA)': AGAp10-30, AGAp30-50 and AGA > p50 (reference), using one-way ANOVA and post hoc test.

Results: There were significantly more MVM lesions in the SGA group (94.6% p <.0001), but also in the AGAp10-30 (67.3% p <.0001) and AGAp30-50 (41.6% p = 0.002), compared to the reference AGA group (19.3%). The prediction of MVM for a 20% false-positive rate, with maternal characteristics was 25.2%. The addition of birthweight percentile gave a prediction of 51.7% for MVM. However adding placental biomarkers and fetal growth velocities (instead of birthweight percentile) to the maternal characteristics, gave a prediction of 81.8% (PPV 49.5%, NPV 53.7%).

Discussion: Placental MVM lesions correlated inversely with birthweight even in AGA neonates, and was associated with slower fetal growth and more adverse outcome in SGA neonates. A combination of first trimester biomarkers and fetal growth velocity had good prediction of placental MVM lesions, as an indicator of fetal growth restriction irrespective of neonatal weight.

Original languageEnglish
Pages (from-to)8-15
Number of pages8
JournalPlacenta
Volume87
DOIs
Publication statusPublished - Nov 2019

Keywords

  • Fetal growth restriction
  • Placenta pathology
  • Maternal vascular malperfusion
  • Birth weight centile
  • Ultrasound
  • FOR-GESTATIONAL-AGE
  • ANTIANGIOGENIC FACTORS
  • ARTERY DOPPLER
  • PREECLAMPSIA
  • PREGNANCY
  • PREDICTION
  • OUTCOMES
  • RISK
  • MORTALITY
  • MALPERFUSION

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