Professor, Neonatology PGIMER,Chandigarh Chandigarh, Chandigarh, India
Background: Placental growth factor (PlGF), a potent angiogenic moderator, partly modulates the activity of vascular endothelial growth factor (VEGF) and in chronic uteroplacental ischemia may lead to low maternal plasma concentration of PlGF in patients destined to develop preeclampsia (PE) or can lead to Intra uterine growth restriction (IUGR). Various abnormal placental histopathology also can affect fetal growth. Hence we explored the relationship between PlGF and placental histopathology in anthropometry of IUGR neonates at birth and at 1 year CA. Objective: To assess the role of maternal serum placental growth factor (PlGF) and placental histopathology (HP) in predicting weight, length and occipitofrontal circumference (OFC) at birth and at 1year corrected age (CA) in intrauterine growth restricted (IUGR) neonates. Design/Methods: This was an Exploratory study conducted in a Level III neonatal unit over 1 year. All mothers with Singleton pregnancies between 30-40 weeks gestation with IUGR (n=41) and gestation matched normal mothers (n=42) and their neonates enrolled at birth and followed till 1 year CA. Maternal PlGF and HP examination (HPE) of placenta were conducted. Weight, length and OFC were recorded at birth and at 1 year CA and compared with gestation matched appropriate for gestational age (AGA) infants. Outcome measures were predictors of growth at birth and at 1 year CA , comparison of maternal PlGF between IUGR and AGA ,correlation of PlGF with placental HPE, placental weight and anthropometry at birth and at CA 1 yr. A value of < 25th percentile in normal pregnancies was considered as cut-off to indicate low PlGF level. Results: Placental weight and gestation significantly and independently predicted birth weight (p < 0.001) and length (p < 0.001) but not growth at 1 year. Median (IQR) PlGF at >37 weeks was significantly lower (p < 0.001){35(13,51) pg/mL}in IUGR than AGA group{108(65,220) pg/mL} but not at < 37 weeks. There was significant positive correlation of maternal PlGF with birth weight (p=0.001), length (p=0.03), OFC (p=0.016), abnormal placental HPE (p=0.001) and also with weight, length and OFC at 1year CA (p < 0.001) though PlGF was not an independent predictor for weight and length at 1 year CA. Placental histopathology was also significant independent predictor of birth weight and birth length.
Conclusion(s): Placental weight, Placental histopathology and gestation predicted independently birth weight and length . Low PlGF and abnormal placental HPE had significant positive correlation with anthropometry at birth and at 1 year CA.
