The effect of an additional third biochemical marker (placental growth factor [PlGF]) on risk estimation of fetal growth restriction during an early prenatal screening
Authors:   Maternity Hospital No. 17, Branch of the V.V. Veresaev City Clinical Hospital, Moscow, Russian Federation, Shamugiya V.V. , Dobrokhotova Yu.E. ,   Pirogov Russian National Research Medical University, Moscow, Russian Federation, Kuznetsova P.A. ,   Pirogov Russian National Research Medical University, Moscow, Russian Federation, Dzhokhadze L.S. ,   Pirogov Russian National Research Medical University, Moscow, Russian Federation, Ivanova O.G. ,   Maternity Hospital No. 3, Separate Division of the L.A. Vorokhobov City Clinical Hospital No. 67, Moscow, Russian Federation
Published: January 2025

Preeclampsia (PE) and fetal growth restriction (FGR) are placenta-associated complications of pregnancy. The most important stage of their
pathogenesis is impaired trophoblast invasion. Impaired synthesis of vascular growth factors (in particular, placental growth factor [PlGF]) is a marker of the abnormal conditions. During normal pregnancy, PlGF blood level gradually increases until the beginning of the third trimester
when it reaches a plateau. PlGF production significantly reduces in patients with PE and placental insufficiency. In this view, PlGF came to be
regarded as a component of software-based estimation of risks for PE and FGR during the first screening.
Chorionic gonadotropin (HCG) and pegnancy-associated plasma protein-A (РАРР-A) are standard biochemical markers tested during the first
trimester screening. As the third marker, PlGF is widely discussed to be included in the algorithm. It is believed that such an approach may
provide more precise selection of patients with high risk for FGR and PE.
PlGF consideration affects not only an estimated PE risk, but also changes a risk of chromosomal abnormalities (CA). If PlGF is included in the
algorithm, the best part of pregnant women attributed to a low-risk CA group as a result of two biochemical marker-based estimation, may
end up in a high-risk group.
We compared the first trimester screening results and put pregnancy outcomes together in two medical institutions within three years (2020-
2022). In the Department of Antenatal Fetal Care of the first institution (n=10054), software-based risk estimation was carried out using two
biochemical markers (i. e., HCG and РАРР-А). In the second institution (n=3847), PlGF test results were added to the risk estimation as the
third biochemical marker. Pregnant women whose screening was based on the 3 parameters were at risk of having a child with CA (n=3.67%),
PE (n=15.9%), and FGR (n=3.48%). These values were 1.99%, 10.98% and 2.05%, respectively, in pregnant women whose risk estimation was
based on standard parameters. At the same time, CA prediction sensitivity decreased when PlGF has been included in the test.
Thus, PlGF added as the third biochemical marker may lead to extension of high-risk groups for FGR, PE, and CA. In turn, this results in
increased incidence of invasive interventions and extension of a group of patients taking acetylsalicylic acid without increasing efficiency.
KEYWORDS: PlGF, FGR, fetal growth restriction, preeclampsia, prevention, chromosomal abnormalities.
FOR CITATION: Shamugiya V.V., Dobrokhotova Yu.E., Kuznetsov P.A., Dzhokhadze L.S., Ivanova O.G. The effect of an additional third
biochemical marker (placental growth factor [PlGF]) on risk estimation of fetal growth restriction during an early prenatal screening. Russian
Journal of Woman and Child Health. 2024;7(4):317–322 (in Russ.). DOI: 10.32364/2618-8430-2024-7-4-4