Use of third trimester serum biomarkers and ultrasound paameters to predict the small for gestational age infant at delivery

Student thesis: Doctoral ThesisDoctor of Philosophy


Current techniques to identify growth-restricted fetuses, at risk of health
complications, have limited accuracy. Placental insufficiency is a key
pathological process in fetal growth restriction (FGR). I investigated the
potential clinical benefit of placental biomarkers to identify pregnancies
delivering small for gestational age (SGA) infants in pregnancies with suspected
pre-eclampsia and in those with reduced symphysis-fundal height measurement
using delivery of an SGA infant as a surrogate measure of FGR.
Suspected pre-eclampsia (PELICAN-PE study)
In a large multicentre prospective cohort study investigating diagnostic accuracy
of placental growth factor (PlGF) in women with suspected pre-eclampsia, I
assessed test performance of 47 biomarkers and ultrasound parameters to
identify women delivering an SGA infant.
PlGF measurement outperformed all other biomarkers and currently used tests
in predicting delivery of an SGA infant. Combinations of biomarkers added
minimal value.
Reduced symphysis-fundal height measurement (PELICAN-FGR study)
I assessed the ability of PlGF and ultrasound parameters to predict delivery of
an SGA infant in women with reduced symphysis-fundal height (current UK
standard to identify pregnancies at risk of SGA) in a second multinational
prospective cohort study. Test performance statistics were calculated for all
parameters in isolation and combination.
Ultrasound parameters had modest test performance for predicting delivery of
an SGA infant. PlGF performed no better. Incorporating PlGF with ultrasound
parameters provided modest improvements.
In women presenting with suspected pre-eclampsia, PlGF measurement is a
potentially useful adjunct to current practice in identifying those at risk of SGA.
The findings of the PELICAN-FGR study cannot support the use of PlGF to risk
stratify women referred with reduced symphysis-fundal height. The prevalence
of FGR in the two studies differed, with a high number of normal pregnancies in
those presenting with reduced symphysis-fundal height. The pathological
process in normotensive versus hypertensive SGA may differ, potentially
explaining these findings.
Date of Award2015
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorAndrew Shennan (Supervisor) & Lucy Chappell (Supervisor)

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