Angiogenic imbalance and prognostic criteria in the development of fetal growth restriction

Among the main obstetric complications that contribute to perinatal morbidity and mortality, fetal growth restriction (FGR) is an important one, the proportion of which ranges from 25% among full-term infants to 18-40% among premature newborns. Аim - to evaluate the diagnostic value of biomarkers of placental dysfunction and certain angiogenesis factors in pregnant women with FGR and preterm delivery. Materials and methods. A clinical and laboratory examination was performed in 88 patients aged 18 to 35 years with manifestations of FGR. The main group included 44 patients with FGR and early delivery, and the comparison group included 44 patients with FGR and urgent delivery. The control group consisted of 30 conditionally healthy pregnant women. The level of serum markers was assessed: PAPP-A and β-subunit of chorionic gonadotropin (β-hCG), and certain angiogenesis factors (PlGF, sFlt-1, VEGF). Results. In the main group, the proportion of surgical delivery was 35.2%, preterm delivery - 52.3%, and low Apgar score - 47.7%. The risk of preterm delivery was 3.4 times higher in the case of early FGR. In the main group, the level of PAPP-A was consistently low (2.5 times), hCG β-subunit - by 2.4 times, and two thirds (70.5%) were diagnosed with haemodynamic disorders up to 28-30 weeks. The PlGF levels are already lower than normal at 12-14 weeks of pregnancy (47.7%), at 20-22 weeks (61.4%), VEGF-1 concentration is reduced by 1.9 times, and sFlt-1 levels increase by 1.9 times. In the case of an increase in the sFlt-1/PlGF ratio by 100 conditional units during 10-14 days of monitoring, the risk of haemodynamic disorders of feto-paternal circulation in patients with FGR increased by 3.0 times. Conclusions. The data on the dynamics of secretion of certain placental proteins and growth factors can be used to formulate screening programmes. In women with FGR, PlGF content demonstrates low parameters, deviations in the proangiogenic factor VEGF-1, imbalance of vascular factors in the dynamics of pregnancy and an increase in the angiogenic coefficient, which can be considered as a prognostic marker of incomplete trophoblast invasion and the risk of placental dysfunction. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from participant. The authors declare no conflict of interest.