OC02.04: *Association between adverse neonatal outcome and maternal hemodynamics and biomarkers in small for gestational age and fetal growth restriction

We aimed to assess whether maternal biomarkers or hemodynamics were associated with composite adverse neonatal outcome (CANO) in small for gestational age (SGA) and fetal growth restriction (FGR). Participants were 18 years or older, pregnant with a singleton non-anomalous SGA fetus (AC or EFW <10th percentile or 50 percentile lower than a previous ultrasound) between 32 and 36+6 weeks GA. Maternal hemodynamics and biomarkers were assessed at the time of inclusion. CANO included fetal/neonatal mortality, poor condition at birth, need for respiratory support, cardiovascular abnormality, brain injury syndromes, sepsis and retinopathy of prematurity. Biomarkers (sFlt-1, PlGF) and hemodynamic variables were reported as modified z-scores using published (Roche®, USCOM®, and Arteriograph®) or unpublished (Vicorder®) normal ranges. Differences between groups were evaluated using the Wilcoxon-Mann-Whitney test and the Dunn's test for adjusted multiple comparisons. The univariate analysis included maternal age, BMI, nulliparity, GA at inclusion, hypertension at inclusion, abnormal Doppler before 37 weeks, and all hemodynamic variables and biomarkers. Significant predictors were then included in the multivariable logistic model with potential confounders. 241 participants with paired maternal hemodynamic and biomarker assessments were included. EFW at inclusion, GA at inclusion, presence of abnormal Doppler before 37 weeks, stroke volume, sFlt-1 z-score and PlGF z-score were all significantly associated with CANO at univariate analysis. In the multivariable model EFW at inclusion remained significantly associated with CANO (p < 0.001) as did stroke volume and sFlt-1 z-score (p values 0.029 and 0.038 respectively). The addition of maternal biomarkers and hemodynamic variables to the model improves the prediction of CANO from an AUC of 0.81 to 0.86. In SGA and FGR, EFW is the strongest predictor of CANO. Maternal stroke volume and sFlt-1 add useful predictive value to the model.