Investigation the prognostic value of soluble FMS-liketyrosine kinase-1 (SFLT-1), placental growth factor (PLGF), SFLT-1/PLGF ratio, andalterations in these parameters on time of delivery and maternal-fetalcomplications in pregnant women with fetal intrauterine growth restriction(IUGG).

The aim of this study was to investigate the prognostic value of soluble FMS-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), sFlt-1/PlGF ratio, and alterations in these parameters on time of delivery and maternal-fetal complications in pregnant women with fetal intrauterine growth restriction (IUGG). A total of 42 pregnant women with fetal IUGG between 24 and 36 gestational weeks were included. Women with multiple pregnancies and major fetal congenital abnormalities were excluded. Plasma samples from maternal blood were first collected when fetal IUGG was first diagnosed (first measurement) and, then, one week after the diagnosis (second measurement). The sFlt-1 and PlGF levels and sFlt-1/PlGF ratio of the samples (first and second measurements) were measured. The avarage of the first and second measurements was calculated, and the mean sFlt-1 and PlGF levels and sFlt-1/PlGF ratio were estimated. Blood pressure measurement was performed. Fetal biometry, umbilical artery, middle cerebral artery (MCA), and uterine artery Doppler indices were measured using ultrasonography. All measurements were repeated one week after the diagnosis of fetal IUGG. Of a total of 42 pregnancies with fetal IUGG, 23 (54%) had delivery within four weeks of the first measurement. The mean sFlt-1/PlGF ratio in the first blood samples collected at the time of the diagnosis of fetal IUGG was statistically significantly higher among women with delivery within four weeks of the first measurement than those without. The mean sFlt-1/PlGF ratios were 100.53 and 16.28 in the women with and without delivery within four weeks of the first measurement, respectively (P=0.008). According to the receiver operating characteristic (ROC) curve, a threshold of 12.075 (AUC: 0.739) for the sFlt-1/PlGF was used and sensitivity, specificity, PPV, and NPV were calculated as 69.57%, 84.21%, 84.2%, and 69.6%, respectively in women who had delivery within four weeks of the first measurement. The mean sFlt-1/PlGF ratio of the first and second measurement samples was significantly higher in women with maternal-fetal complications compared to those without any complication. In addition, the mean sFlt-1/PlGF ratio of the first and second measurement samples 91 was 354.41 in the women with preeclampsia and 13.75 in the women without preeclampsia, indicating a statistically significant difference (P<0.001). The mean sFlt-1/PlGF ratio of the first and second measurement samples was 121.74 and 13.36 in the women with infants requiring and not requiring neonatal intensive care (P=0.057). In conclusion, our study results show that time to delivery is reduced in women with fetal IUGG having a higher sFlt-1/PlGF ratio. Similarly, these women are at an increased risk for maternal-fetal complications. Based on these findings, we suggest that pregnant women with a high sFlt-1/PlGF ratio should be closely followed and hospitalized, if necessary, to diagnose and prevent maternal-fetal complications earlier. Keywords: intrauterine growth restriction (IUGG), soluble FMS-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF)