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Recording available 2/16-5/2
Recording available 2/16-5/2
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Poster Session 1

Category: Hypertension

Poster Session 1

(158) Placental Growth Factor Concentrations Predict Genetic Testing Yield in Isolated Severe Early-Onset Fetal Growth Restriction

Wednesday, February 11, 2026
10:30 AM - 12:00 PM  

    Submitting Author and Presenting Author(s)

  • Catherine M. Windrim, MB BCh BAO

    Maternal Fetal Medicine Fellow
    Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    Toronto, Ontario, Canada

    • Coauthor(s)

  • NJ

    Nicole Jarosz

    Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    Toronto, Ontario, Canada

  • NG

    Nicole Gojska

    Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    Toronto, Ontario, Canada

  • John W. Snelgrove, MD, MSc, FRCSC (he/him/his)

    Assistant Professor
    Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    Toronto, Ontario, Canada

  • RG

    Rachel Gladstone

    Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    Toronto, Ontario, Canada

  • Kelsey McLaughlin, PhD

    Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    Toronto, Ontario, Canada

  • Sebastian R. Hobson, MD, MPH, PhD (he/him/his)

    Staff MFM
    Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    Toronto, Ontario, Canada

  • DC

    David Chitayat, MD

    Head
    Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    Toronto, Ontario, Canada

  • HF

    Homero Flores Mendoza

    Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    Toronto, Ontario, Canada

  • RW

    Rory Windrim, MD

    Maternal Fetal Medicine Division, Ontario Fetal Center, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
    Toronto, Ontario, Canada

  • JK

    John C. Kingdom, MD, MD

    Maternal Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
    Toronto, Ontario, Canada

Objective:

To determine whether circulating placental growth factor (PlGF) concentrations can predict genetic testing yield in pregnancies with isolated severe early-onset fetal growth restriction (eoFGR).


Study Design:

Retrospective cohort study of singleton pregnancies with severe eoFGR (< 3rd percentile) at 20-28 weeks gestation between March 2017 and December 2024. Exclusion criteria: stillbirth at evaluation, major fetal structural abnormalities, and major aneuploidy by NIPT. Primary outcome was genetic abnormality detection from amniocentesis or cord blood sampling, stratified by PlGF concentrations using 100 pg/mL threshold.


Results:

Of 291 pregnancies, 91 (31.3%) underwent genetic evaluation. PlGF < 100 pg/mL occurred in 223 cases (76.6%) versus 68 cases (23.4%) with PlGF ≥100 pg/mL. PlGF demonstrated striking inverse relationship with genetic abnormalities: PlGF ≥100 pg/mL yielded 36.8% (14/38) genetic abnormalities versus 5.7% (3/53) in PlGF < 100 pg/mL group (OR 9.72, 95% CI 2.5-37.1, p< 0.001). Low PlGF (< 100 pg/mL) indicated placenta-mediated disease with 94.3% negative predictive value for genetic abnormalities. Genetic testing rates were higher in PlGF ≥100 pg/mL group (55.9% vs 23.8%, p< 0.001). All genetic abnormalities had normal qfPCR results. PlGF < 100 pg/mL group showed predominantly placenta-mediated phenotype with higher maternal vascular malperfusion (75.8% vs 32.4%, p< 0.001), preeclampsia/HELLP syndrome (19.3% vs 7.4%, p=0.02), earlier delivery (29.1 vs 33.9 weeks, p< 0.001), lower birth weights (823g vs 1,500g, p< 0.001), and reduced live births (70.9% vs 85.3%, p=0.02).


Conclusion:

In severe eoFGR, low PlGF (< 100 pg/mL) indicates placenta-mediated disease with excellent negative predictive value (94.3%) for genetic abnormalities, allowing prioritization of maternal health surveillance. High PlGF (≥100 pg/mL) indicates 36.8% genetic abnormality risk not captured by routine screening, supporting amniocentesis consideration. PlGF provides rapid, objective biomarker guidance for distinct clinical pathways in severe eoFGR.