Association between adverse neonatal outcome and maternal haemodynamics and biomarkers in SGA and FGR

Objective. We aimed to assess whether maternal biomarkers or haemodynamics were associated with composite adverse neonatal outcome in small for gestational age (SGA) and foe­tal growth restriction (FGR).
Materials and Methods. Participants were 18 years or older, pregnant with a singleton non-anomalous SGA foetus (AC or EFW < 10th percentile or 50 percentiles lower than a previous ultrasound). Maternal haemodynamics and biomarkers were assessed at the time of inclusion. Composite adverse neonatal outcome included foetal/neonatal mortality, poor condition at birth, need for respiratory support, cardiovascular abnormal­ity, brain injury syndromes, sepsis and retinopathy of prema­turity requiring treatment.
Biomarkers (sFlt, PlGF, sFlt/PlGF) and haemodynamic vari­ables were reported as modified z-scores using published (Roche®, USCOM®, and Arteriograph®) or unpublished (Vi­corder®) normal ranges.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. Univariate analysis demonstrated significant predictors which were then included in the multivariable logistic model with potential confounders.
Results. 359 participants with paired maternal haemodynam­ic and biomarker assessments were included. Mean arterial pressure, sFlt-1 and PlGF were all significantly associated with adverse outcome at univariate analysis. In the multivariable model EFW at inclusion, UCR at inclusion and sFlt-1 z-score remained significant. This model gives an AUC of 0.79 [0.73; 0.86] with a sensitivity of 73.1%, specificity of 75.1% and 74.7% accuracy (using the probability cut-off based on the maximum Youden Index).
Conclusions. In SGA and FGR foetuses, UCR and EFW at in­clusion and sFlt-1 are associated with composite adverse neo­natal outcome.