Placental Growth Factor and Uterine-Artery Doppler for Prediction of Preeclampsia, Fetal Growth Restriction and Early Preterm Birth

OBJECTIVES: To assess whether placental growth factor (PlGF) and uterine artery (UtA) Doppler measured at 20-28 weeks can predict preeclampsia (PE), fetal growth restriction or small for gestational age (FGR/SGA), and preterm birth before 34 weeks (PTB < 34 w). METHODS: From December 2021 to January 2025, PlGF testing and UtA Doppler were offered prospectively between 20 and 28 weeks in a high-risk obstetric population. Low PlGF was defined as <5th percentile for gestational age. Abnormal UtA was defined as a mean pulsatility index >95th percentile or diastolic notching. PE, FGR/SGA, and PTB were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated. RESULTS: Of 223 participants enrolled, 74 had both PlGF and UtA measurements. PE occurred in 14/74 (18.9%), FGR/SGA in 22/74 (29.7%), and PTB < 34 weeks in 19/74 (25.6%). PlGF alone detected PE with 71% sensitivity and 37% PPV, FGR/SGA with 68% sensitivity and 60% PPV, and PTB < 34 weeks with 68% sensitivity and 57% PPV. UtA alone had low sensitivity (45%-53%) and PPV (28%-53%). Low PlGF and/or abnormal UtA maximized sensitivity, 86% for PE, 68% for FGR/SGA, and 74% for PTB < 34 weeks, but reduced specificity (57%-60%). Low PlGF plus abnormal UtA improved PPV for FGR/SGA (77%) and PTB < 34 weeks (82%) but had limited sensitivity (36%-47%). CONCLUSIONS: PlGF measurement alone showed superior predictive power for PE, FGR/SGA, and PTB < 34 weeks. UtA Doppler combined with PlGF enhanced sensitivity or raised PPV. Abnormal UtA without low PlGF provided minimal incremental detection.