Clinical trial NCT05151289: Diagnostic Value of sFlt-1/PlGF Ratio for the Etiology of Intra Uterine Growth Restriction - ANGIOPAG
Official title: Diagnostic Value of sFlt-1/PlGF Ratio for the Etiology of Intra Uterine Growth Restriction
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Intrauterine Growth Restriction
Fetal Growth Restriction (FGR)
Keywords: sFlt1
PlGF
IUGR
intrauterine growth restriction
fetal growth restriction
Lead sponsor: Assistance Publique - Hôpitaux de Paris
Sponsor class: OTHER
First posted: 2021-12-09
Enrollment: 152
Sex: FEMALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Patients consulting in one of the participating centers for intra uterine growth restriction.
Primary purpose: DIAGNOSTIC

Brief summary: The main aim of this project is to determine the Placental Growth Factor and Vascular Endothelial Growth Factor ratio's performance (sFlt-1/PlGF) for the etiological diagnosis of vascular Intrauterine growth restriction (IUGR) compared to a non-vascular IUGR.

Detailed description: Intra-uterine growth restriction is one of the most frequent cause of consultation in prenatal diagnosis centers. Suspected Intrauterine growth restriction (IUGR) concerns 5.4% of pregnancies. Prognosis and management of IUGR depends on its etiology. It has been estimated that 80 to 90% of IUGR have a vascular cause, 5-15% an infectious cause and 2 to 5% chromosomal or genetic cause. More recently, a meta-analysis has shown that among 874 IUGR fetuses for whom amniocentesis was performed, anomaly of caryotype or comparative genomic hybridization array was reported for 6%. In case of vascular IUGR, amniocentesis is not indicated and close surveillance of mother and fetus is organized.

The diagnosis of vascular IUGR is most often confirmed after birth with placental histology. Before birth, the diagnosis of vascular IUGR is presumptive, and based on gestational age at diagnosis, quantity of amniotic fluid, end dopplers of umbilical artery and uterine arteries. The argument considered as most specific of vascular IUGR is the doppler of uterine arteries, however it has been shown that sensitivity of this test is weak : abnormal uterine arteries is reported in only 40% of fetuses with vasculat IUGR according to placenta pathology.

Biochemical markers Placental Growth Factor and Vascular Endothelial Growth Factor (sFlt1 and PlGF) have shown their prognostic value on the occurrence of preeclampsia. They are both associated to the delay until occurrence of preeclampsia and to the delay before extraction in case of IUGR. As diagnostic tool in IUGR, only two studies have investigated their value : the PlGF/sFlt-1 ratio identified 7 patients among 10 with abnormal placental pathology, and low PlGF value is associated with abnormal placental pathology among 122 cases of IUGR, however this study did not specify sensitivity and specificity values. A reliable and reproductible marker that could orient practitioners towards the need to propose amniocentesis at diagnosis of IUGR is therefore important to develop.

The main objective of ANGIOPAG is to determine the sFlt-1/PlGF ratio's performance for the etiological diagnosis of vascular IUGR compared to a non-vascular IUGR.

To reach this goal, ANGIOPAG is a diagnostic, multicenter, non-randomized study. It will be performed on 152 pregnant women over 18 with a term between 22and 34 +6 Weeks of Gestation (WG), consulting in participating centers for IUGR. For the research, a blood test will be carried, at the inclusion and 2 to 4 weeks after, to determine sFLT-1 and PlGF. All included patients'placenta will be analyzed, even in case of a child normal birth weight.

Eligibility criteria: Inclusion Criteria:

* \> 18 years old
* Singleton pregnancy
* Date of conception evaluated by ultrasound \< 14 WG
* Consulting in one of the 3 participating centers for IUGR
* Estimated fetal weight \< 5th centile (according to Hadlock 3 et CFEF)
* Between 22+0 WG et 34+6 WG

Exclusion Criteria:

* Major birth defect diagnosed at time of inclusion
* Abnormality of caryotype known at time of inclusion
* Confirmed preeclampsia at time of inclusion

Primary outcomes:
measure: To compare the PlGF / sFlt-1 ratio and placental lesions to confirm the diagnosis of vascular intrauterine growth retardation
timeFrame: 34+6 Weeks of Gestation
Secondary outcomes:
measure: Delay between inclusion and birth
timeFrame: 21 weeks after inclusion
measure: Occurrence of preeclampsia
timeFrame: 21 weeks after inclusion
measure: Gestational age at birth
timeFrame: maximum 21 weeks after inclusion
measure: Birth weight
timeFrame: maximum 21 weeks after inclusion
measure: Newborn evaluation (presence of birth defects)
timeFrame: maximum 21 weeks after inclusion
measure: Rate of transfers to intensive care unit
timeFrame: maximum 21 weeks after inclusion
measure: Rate of death of babies
timeFrame: maximum 21 weeks after inclusion
Other outcomes:
Locations:
city: Colombes
country: France
facility: Hôpital Louis Mourier
Study officials:
affiliation: Assistance Publique - Hôpitaux de Paris
name: Jeanne Sibiude, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References: