Prediction of delivering a small for gestational age infant and adverse perinatal outcome in women with suspected pre-eclampsia.

OBJECTIVE: To evaluate the test performance of 47 biomarkers and ultrasound parameters to predict subsequent delivery of an SGA infant and adverse perinatal outcome in women presenting with suspected preeclampsia. METHODS: In a prospective, multicentre observational study, 47 biomarkers and ultrasound parameters were measured in 397 women presenting with suspected preterm preeclampsia, with the objective of evaluating them as predictors of subsequent delivery of an SGA infant and adverse perinatal outcome. Factor analysis and stepwise logistic regression were performed in two pre-specified groups. RESULTS: In 274 women presenting at 20(+0) to 34(+6) weeks' gestation (Group 1), 96 (35%) delivered an SGA infant <3(rd) customised birthweight centile (SGA-3). For prediction of SGA-3, low maternal Placental Growth Factor (PlGF) concentrations had a sensitivity of 93% (95%CI 84% to 98%) and negative predictive value (NPV) of 90% (95%CI 76% to 97%) compared to a sensitivity of 71% (95%CI 58% to 82%) and a NPV of 79% (95%CI 68% to 87%) for ultrasound parameters (estimated fetal weight or abdominal circumference <10(th) centile). No individual biomarker evaluated had superior performance to PlGF and combinations added only small increments to test performance. Similar results were found in 123 women presenting between 35(+0) to 36(+6) weeks' gestation (Group 2). CONCLUSIONS: In women presenting with suspected preterm preeclampsia, measurement of PlGF offers a useful adjunct for identifying those at high risk of delivering an SGA infant, allowing appropriate surveillance and timely intervention.