Managing early-onset small-for-gestational-age (SGA) fetuses remains a significant clinical challenge. Clinicians must accurately predict composite adverse perinatal outcomes (CAPO) to optimize care. Recent research highlights the combined utility of angiogenic factors fetal doppler measurements. These markers help distinguish between constitutionally small fetuses and those suffering from placental insufficiency. Specifically, placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) serve as vital biomarkers. Their ratio reflects the severity of placental dysfunction. However, the presence of pre-eclampsia (PE) often complicates these assessments. This study specifically aimed to delineate the contribution of PE to the predictive value of these markers.

Improving Prediction with Angiogenic Factors Fetal Doppler

Researchers conducted a retrospective study at Vall d'Hebron University Hospital to analyze singleton pregnancies with low estimated fetal weight. Consequently, they found that the sFlt-1/PlGF ratio strongly predicts adverse outcomes. When clinicians integrate Doppler indices, the predictive accuracy improves further. Moreover, this combined approach remains effective even in cases without pre-eclampsia. Additionally, fetal Doppler provides independent prognostic information regarding fetal well-being. Therefore, using both biochemical and ultrasound markers allows for better risk stratification. This synergy helps healthcare providers plan surveillance and delivery more effectively. In addition, the study confirms that the sFlt-1/PlGF ratio ≥ 85 carries a high sensitivity for predicting adverse outcomes.

FAQs

How do angiogenic factors improve the management of small fetuses?

Angiogenic factors like the sFlt-1/PlGF ratio provide a direct measure of placental health. They help clinicians identify fetuses at high risk for complications, even before ultrasound changes occur.

Does pre-eclampsia change the accuracy of these markers?

While pre-eclampsia is strongly associated with angiogenic imbalance, these markers remain reliable predictors of adverse outcomes in growth-restricted fetuses even without a PE diagnosis.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Bonacina E et al. Angiogenic factors and fetal Doppler for predicting adverse pregnancy outcome in early-onset small fetuses with and without pre-eclampsia. Ultrasound Obstet Gynecol. 2026 Feb 22. doi: 10.1002/uog.70188. PMID: 41723869.


2. Byrne Z et al. Maternal sFlt-1/PlGF Ratio to Distinguish Pathological Fetal Growth Restriction From Constitutional Smallness: Systematic Review. BJOG. 2026 Jan 5. doi: 10.1111/1471-0528.70128.


3. Dymara-Konopka W et al. Is the sFlt-1/PlGF ratio efficient in predicting adverse neonatal outcomes in small-for-gestational-age newborns? Front. Endocrinol. 2024.

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