Fetal growth restriction and placental markers: а retrospective study of first-trimester predictors
DOI:
https://doi.org/10.2478/amb-2026-0043Keywords:
fetal growth restriction, PAPP-A, uterine artery Doppler, first-trimester screening, β-hCG, placental functionAbstract
Background: Prenatal care must prioritise the early detection of Fetal growth restriction (FGR), as it is a major contributing cause of postnatal problems and deaths. Early detection of risk in pregnancies for FGR plays an essential role in optimizing prenatal care and improving outcomes. Maternal serum biomarkers and uterine artery Doppler measurements during the initial trimester have been proposed as potential predictors. Aim: The purpose of this research was to find the connection between uterine artery Doppler indices and maternal blood markers from the first trimester and the emergence of FGR later on. Materials and methods: This retrospective study of 642 singleton pregnancies monitored at a specialized fetal medicine unit between January, 2023 and December, 2024. All women underwent first-trimester examination between 11+0 and 13+6 weeks of pregnancy, which involved evaluating PAPP-A, or pregnancy-associated plasma protein A, free beta-human chorionic gonadotrophin (β-hCG), and the pulsatility index (PI) of the uterine artery via Doppler ultrasound. A birth weight below the third percentile was referred to as FGR. Results: Fetal growth restriction (FGR) was diagnosed in 65 patients (10.1%). A higher mean uterine artery pulsatility index (PI) (1.93 ± 0.68) and lower maternal serum pregnancy-associated plasma protein A (PAPP-A) levels (0.56 ± 0.26 MoM) were significantly more common in affected pregnancies compared with unaffected pregnancies (PAPP-A: 1.18 ± 0.56 MoM; PI: 1.57 ± 0.45; p = 0.001 and p = 0.014, respectively). There was no statistically significant difference in β-hCG levels between the two groups. Multivariate logistic regression analysis confirmed elevated uterine artery PI and low PAPP-A levels as independent predictors of FGR risk. Conclusion: High uterine artery PI and decreased PAPP-A levels in the mother’s blood during the first trimester are both linked to a higher risk of fetal growth limitation. Although their predictive capacity is limited, these markers may aid in early risk stratification when used in conjunction with other clinical assessments.
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